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Toward a Change Among the Epidemiology of Catheter-Related Bloodstream Infections in Catalonia
- Oriol Gasch, Marta Andrés, Jordi Camara, L’Hospitalet de Llobregat, Dolors Domenech, Emili Jimenez, L'Hospitalet de Llobregat, Anna Marrón, Yolanda Meije, Virginia Pomar, Patrick Saliba, Esther Calbo
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s413
- Print publication:
- October 2020
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- Article
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Background: Catheter-related bloodstream infections (CRBSIs) are one of the most frequent causes of heathcare-associated infections and an important cause of preventable death. Central venous catheters (CVC) have been considered the most worrisome origin of CRBSI. Implemented preventive measures at most hospitals and published guidelines for the prevention of vascular catheter infections have focused mostly on CVCs. However, peripherally inserted venous catheters (PIVC)–related bloodstream infections have increased in recent years and are currently among the top 10 patient safety concerns for 2019. Objective: We describe the changes in the epidemiology of catheter-related bloodstream infections among acute-care hospitals reporting at the VINCat program (Infection Control and Antimicrobial Stewardship Catalan Program) from 2008 to 2018. Methods: Data on 55 hospitals in Catalonia reporting all the episodes of CRBSI diagnosed according to standardized definitions during 2008–2018 were used for the analysis. Participating hospitals were classified into 3 groups according to size: group 1 (>500 beds), 9 hospitals; group 2 (500–200 beds), 17 hospitals; and group 3 (<200 beds), 29 hospitals. Catheters were classified in 3 categories: CVCs, PICVCs, and short peripheral venous catheters (PVCs). Rates of catheter-related bloodstream infection (CR-BSI) were obtained by adjusting the total number of episodes by 1,000 hospital stays. Simple linear regressions were performed. Values of P ≤ .05 were considered statistically significant. Results: During the study period, 8,221 nosocomial episodes of CRBSI were diagnosed among the 55 participating hospitals. In total, 37,587,967 hospital stays were counted. The CRBSI rate was 0.22 episodes per 1,000 hospital stays (group 1, 0.28; group 2, 0.15; and group 3, 0.16), following a downward trend from 2008 to 2018 from 0.28 to 0.21 per 1,000 hospital stays (P < .005). Among them, CVC-BSI showed a downward trend (from 610 annual episodes in 2008 to 312 in 2018), and PICVC and PVC showed an upward trend (from 51 and 120 annual episodes in 2008 to 130 and 312 in 2018, respectively). Annual rates of PICVCs and PVCs showed an upward trend, but CVCs showed a downward trend in 2018 (P < .05): 0.09 per 1,000 hospital stays for PICVCs; 0.07 per 1,000 hospital stays for PVCs, and 0.04 episodes per 1,000 hospital stays for CVCs (Fig. 1). Conclusions: PIVC-related bloodstream infections have increased in recent years, whereas bloodstream infections related to CVC have followed a downward trend. Our hospitals should implement preventive measures to specially address the prevention of PICVC infections.
Funding: None
Disclosures: None
Comparison of Predictors and Mortality Between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae
- Oded Scheuerman, Vered Schechner, Yehuda Carmeli, Belen Gutiérrez-Gutiérrez, Esther Calbo, Benito Almirante, Pier-Luigy Viale, Antonio Oliver, Patricia Ruiz-Garbajosa, Oriol Gasch, Monica Gozalo, Johann Pitout, Murat Akova, Carmen Peña, Jose Molina, Alicia Hernández-Torres, Mario Venditti, Nuria Prim, Julia Origüen, German Bou, Evelina Tacconelli, Maria Tumbarello, Axel Hamprecht, Ilias Karaiskos, Cristina de la Calle, Federico Pérez, Mitchell J. Schwaber, Joaquin Bermejo, Warren Lowman, Po-Ren Hsueh, Carolina Navarro-San Francisco, Robert A. Bonomo, David L. Paterson, Alvaro Pascual, Jesus Rodríguez-Baño, the REIPI/ESGBIS/INCREMENT investigators
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 39 / Issue 6 / June 2018
- Published online by Cambridge University Press:
- 05 April 2018, pp. 660-667
- Print publication:
- June 2018
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OBJECTIVE
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
METHODSAs part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
RESULTSThe study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
CONCLUSIONSClinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
CLINICAL TRIALS IDENTIFIERClinicalTrials.gov. Identifier: NCT01764490.
Infect Control Hosp Epidemiol 2018;39:660–667