Kuan-Yin Lin1, Aristine Cheng2, Yu-Ching Chang3, Mei-Chuan Hung3, Jann-Tay Wang4, Wang-Huei Sheng5, Po-Ren Hseuh6, Yee-Chun Chen4, Shan-Chwen Chang4. 1. Center for Drug Evaluation, Taipei, Taiwan. 2. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan. 3. Infection Control Center, National Taiwan University Hospital, Taipei, Taiwan. 4. Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. 5. Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: whsheng@ntu.edu.tw. 6. Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Abstract
BACKGROUND/ PURPOSE: Patients admitted to intensive care units (ICUs) are at high risk for central line-associated bloodstream infections (CLABSIs). Bundle care has been documented to reduce CLABSI rates in Western countries, however, few reports were from Asian countries and the differences in the epidemiology or outcomes of critically-ill patients with CLABSIs after implementation of bundle care remain unknown. We aimed to evaluate the incidence, microbiological characteristics, and factors associated with mortality in critically-ill patients after implementation of bundle care. METHODS: Prospective surveillance was performed on patients admitted to ICUs at the National Taiwan University Hospital, Taipei, Taiwan from January 2012 to June 2013. The demographic, microbiological, and clinical data of patients who developed CLABSI according to the National Healthcare Safety Network definition were reviewed. A total of 181 episodes of CLABSI were assessed in 156 patients over 46,020 central-catheter days. RESULTS: The incidence of CLABSI was 3.93 per 1000 central-catheter days. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (39.2%), followed by Gram-positive bacteria (33.2%) and Candida spp. (27.6%). Median time from insertion of a central catheter to occurrence of CLABSI was 8 days. In multivariate analysis, the independent factors associated with mortality were higher Pitt bacteremia score [odds ratio (OR) 1.41; 95% confidence interval (CI) 1.18-1.68] and longer interval between onset of CLABSIs and catheter removal (OR 1.10; 95% CI 1.02-1.20), respectively. CONCLUSION: In institutions with a high proportion of CLABSI caused by Gram-negative bacteria, severity of bacteremia and delay in catheter removal were significant factors associated with mortality.
BACKGROUND/ PURPOSE:Patients admitted to intensive care units (ICUs) are at high risk for central line-associated bloodstream infections (CLABSIs). Bundle care has been documented to reduce CLABSI rates in Western countries, however, few reports were from Asian countries and the differences in the epidemiology or outcomes of critically-illpatients with CLABSIs after implementation of bundle care remain unknown. We aimed to evaluate the incidence, microbiological characteristics, and factors associated with mortality in critically-illpatients after implementation of bundle care. METHODS: Prospective surveillance was performed on patients admitted to ICUs at the National Taiwan University Hospital, Taipei, Taiwan from January 2012 to June 2013. The demographic, microbiological, and clinical data of patients who developed CLABSI according to the National Healthcare Safety Network definition were reviewed. A total of 181 episodes of CLABSI were assessed in 156 patients over 46,020 central-catheter days. RESULTS: The incidence of CLABSI was 3.93 per 1000 central-catheter days. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (39.2%), followed by Gram-positive bacteria (33.2%) and Candida spp. (27.6%). Median time from insertion of a central catheter to occurrence of CLABSI was 8 days. In multivariate analysis, the independent factors associated with mortality were higher Pitt bacteremia score [odds ratio (OR) 1.41; 95% confidence interval (CI) 1.18-1.68] and longer interval between onset of CLABSIs and catheter removal (OR 1.10; 95% CI 1.02-1.20), respectively. CONCLUSION: In institutions with a high proportion of CLABSI caused by Gram-negative bacteria, severity of bacteremia and delay in catheter removal were significant factors associated with mortality.
Authors: Niccolò Buetti; Elia Lo Priore; Andrew Atkinson; Andreas F Widmer; Andreas Kronenberg; Jonas Marschall Journal: BMJ Open Date: 2018-12-22 Impact factor: 2.692