Hostname: page-component-848d4c4894-p2v8j Total loading time: 0.001 Render date: 2024-05-19T12:24:08.133Z Has data issue: false hasContentIssue false
  • English
  • Français

A ten-year review of healthcare-associated bloodstream infections from forty hospitals in Québec, Canada

Published online by Cambridge University Press:  29 August 2018

Iman Fakih ,
Élise Fortin ,
Marc-André Smith ,
Alex Carignan ,
Claude Tremblay ,
Jasmin Villeneuve ,
Danielle Moisan ,
Charles Frenette ,
Caroline Quach Open the ORCID record for Caroline Quach [Opens in a new window]  and
for SPIN-BACTOT
Iman Fakih
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada
Élise Fortin
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Québec, Canada
Marc-André Smith
Affiliation:
CIUSSS du Nord-de-l’Île-de-Montréal, Québec, Canada
Alex Carignan
Affiliation:
Department of Microbiology and Infectious Diseases, Sherbrooke University, Québec, Canada
Claude Tremblay
Affiliation:
CHU de Québec, Québec, Canada
Jasmin Villeneuve
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
Danielle Moisan
Affiliation:
CISS du Bas-Saint-Laurent, Québec, Canada
Charles Frenette
Affiliation:
Department of Medical Microbiology, McGill University Health Centre, Québec, Canada
Caroline Quach*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Québec, Canada Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Québec, Canada
for SPIN-BACTOT
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Québec, Canada CIUSSS du Nord-de-l’Île-de-Montréal, Québec, Canada Department of Microbiology and Infectious Diseases, Sherbrooke University, Québec, Canada CHU de Québec, Québec, Canada CISS du Bas-Saint-Laurent, Québec, Canada Department of Medical Microbiology, McGill University Health Centre, Québec, Canada Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Québec, Canada
*
Author for correspondence: Caroline Quach, CHU Sainte-Justine, 3175 ch Côte Sainte-Catherine, Suite B.17.102, Montréal, QC H3T 1C5. E-mail: c.quach@umontreal.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Healthcare-associated bloodstream infections (HABSI) are a significant cause of morbidity and mortality worldwide. In Québec, Canada, HABSI arising from acute-care hospitals have been monitored since April 2007 through the Surveillance des bactériémies nosocomiales panhospitalières (BACTOT) program, but this is the first detailed description of HABSI epidemiology.

Methods

This retrospective, descriptive study was conducted using BACTOT surveillance data from hospitals that participated continuously between April 1, 2007, and March 31, 2017. HABSI cases and rates were stratified by hospital type and/or infection source. Temporal trends of rates were analyzed by fitting generalized estimating equation Poisson models, and they were stratified by infection source.

Results

For 40 hospitals, 13,024 HABSI cases and 23,313,959 patient days were recorded, for an overall rate of 5.59 per 10,000 patient days (95% CI, 5.54–5.63). The most common infection sources were catheter-associated BSIs (23.0%), BSIs secondary to a urinary focus (21.5%), and non–catheter-associated primary BSIs (18.1%). Teaching hospitals and nonteaching hospitals with ICUs often had rates higher than nonteaching hospitals without ICUs. Annual HABSI rates did not exhibit statistically significant changes from year to year. Non–catheter-associated primary BSIs were the only HABSI type that exhibited a sustained change across the 10 years, increasing from 0.69 per 10,000 patient days (95% CI, 0.59–0.80) in 2007–2008 to 1.42 per 10,000 patient days (95% CI, 1.27–1.58) in 2016–2017.

Conclusions

Despite ongoing surveillance, overall HABSI rates have not decreased. The effect of BACTOT participation should be more closely investigated, and targeted interventions along alternative surveillance modalities should be considered, prioritizing high-burden and potentially preventable BSI types.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1202 - 1209
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Si, D, Runnegar, N, Marquess, J, Rajmokan, M, Playford, EG. Characterising healthcare-associated bloodstream infections in public hospitals in Queensland, 2008–2012. Med J Austral 2016;204:1.Google Scholar
2. Redder, JD, Leth, RA, Moller, JK. Incidence rates of hospital-acquired urinary tract and bloodstream infections generated by automated compilation of electronically available healthcare data. J Hosp Infect 2015;91:231–236.Google Scholar
3. Kanamori, H, Weber, DJ, DiBiase, LM, et al. Longitudinal trends in all healthcare-associated infections through comprehensive hospital-wide surveillance and infection control measures over the past 12 years: substantial burden of healthcare-associated infections outside of intensive care units and “other” types of infection. Infect Control Hosp Epidemiol 2015;36:1139–1147.Google Scholar
4. Brady, M, Oza, A, Cunney, R, Burns, K. Attributable mortality of hospital-acquired bloodstream infections in Ireland. J Hosp Infect 2017;96:35–41.Google Scholar
5. Goto, M, Al-Hasan, MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013;19:501–509.Google Scholar
6. Lenz, R, Leal, JR, Church, DL, Gregson, DB, Ross, T, Laupland, KB. The distinct category of healthcare associated bloodstream infections. BMC Infect Dis 2012;12:85.Google Scholar
7. Taylor, G, Gravel, D, Matlow, A, et al. Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence surveys. Antimicrob Resist Infect Control 2016;5:19.Google Scholar
8. Gastmeier, P, Brauer, H, Sohr, D, et al. Converting incidence and prevalence data of nosocomial infections: results from eight hospitals. Infect Control Hosp Epidemiol 2001;22:31–35.Google Scholar
9. Freeman, J, Hutchison, GB. Prevalence, Incidence and duration. Am J Epidemiol 1980;112:707–723.Google Scholar
10. Beyersmann, J, Gastmeier, P, Wolkewitz, M, Schumacher, M. An easy mathematical proof showed that time-dependent bias inevitably leads to biased effect estimation. J Clin Epidemiol 2008;61:1216–1221.Google Scholar
11. Fortin, E, Rocher, I, Frenette, C, Tremblay, C, Quach, C. Healthcare-associated bloodstream infections secondary to a urinary focus: the Quebec provincial surveillance results. Infect Control Hosp Epidemiol 2012;33:456–462.Google Scholar
12. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
13. SPIN-BACTOT. Résultats de surveillance 2016–2017. Quebec: Institut national de santé publique du Québec (INSPQ); 2017.Google Scholar
14. Ayanian, JZ, Weissman, JS. Teaching hospitals and quality of care: a review of the literature. Milbank Qtrly 2002;80:25.Google Scholar
15. Scheckler, WE, Bobula, JA, Beamsley, MB, Hadden, ST. Bloodstream infections in a community hospital: a 25-year follow-up. Infect Control Hosp Epidemiol 2003;24:936–941.Google Scholar
16. Buetti, N, Marschall, J, Atkinson, A, Kronenberg, A, Swiss Centre for Antibiotic R. National bloodstream infection surveillance in Switzerland 2008–2014: different patterns and trends for university and community hospitals. Infect Control Hosp Epidemiol 2016;37:1060–1067.Google Scholar
17. Tong, EN, Clements, AC, Haynes, MA, Jones, MA, Morton, AP, Whitby, M. Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study. BMC Infect Dis 2009;9:145.Google Scholar
18. Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in US hospitals analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:11.Google Scholar
19. Campagne québécoise des soins sécuritaires. https://www.inspq.qc.ca/expertises/maladies-infectieuses/infections-nosocomiales-et-risques-infectieux-en-milieu-de-soins/les-infections-nosocomiales/campagne-soins-securitaires. Accessed June 28, 2018.Google Scholar
20. Nielsen, SL, Pedersen, C, Jensen, TG, Gradel, KO, Kolmos, HJ, Lassen, AT. Decreasing incidence rates of bacteremia: a 9-year population-based study. J Infect 2014;69:51–59.Google Scholar
21. Skogberg, K, Lyytikainen, O, Ollgren, J, Nuorti, JP, Ruutu, P. Population-based burden of bloodstream infections in Finland. Clin Microbiol Infect 2012;18:E170–E176.Google Scholar
22. Sogaard, M, Norgaard, M, Dethlefsen, C, Schonheyder, HC. Temporal changes in the incidence and 30-day mortality associated with bacteremia in hospitalized patients from 1992 through 2006: a population-based cohort study. Clin Infect Dis 2011;52:61–69.Google Scholar
23. Uslan, DZ, Crane, SJ, Steckelberg, JM, et al. Age- and sex-associated trends in bloodstream infection: a population-based study in Olmsted County, Minnesota. Arch Intern Med 2007;167:6.Google Scholar
24. Valles, J, Calbo, E, Anoro, E, et al. Bloodstream infections in adults: importance of healthcare-associated infections. J Infect 2008;56:27–34.Google Scholar
25. Li, L, Fortin, E, Tremblay, C, Ngenda-Muadi, M, Quach, C. Central-line–associated bloodstream infections in Quebec intensive care units: results from the provincial healthcare-associated infections surveillance program (SPIN). Infect Control Hosp Epidemiol 2016;37:1186–1194.Google Scholar
26. Inpatient Hospitalizations: Volumes, Length of Stay and Standardized Rates. Canadian Institute for Health Information (CIHI); 2018. HAS5.Google Scholar