Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance study

Conrick-Martin, Ian; Foley, Michael R.; Roche, Fiona; Fraher, Marianne; Burns, Karen; Morrison, Paul J.; Healy, Marie; Power, Michael; Fitzpatrick, Fidelma; Phelan, Dermot; Walshe, Criona M

doi:10.1016/j.jhin.2012.11.020

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…1 000 catheter days, in-patient days or admissions) applied, vary greatly. If one compare our MC-CRBSI rate (10.1 per 1 000 catheter days; 0.57 per 1 000 in-patient days or 3.7 per 1 000 admissions), regardless of the reporting denominator, to studies in Europe (2.1 per 1 000 catheter days) [ 19 ], Spain (2.5 per 1 000 admissions) [ 18 ], Israel (0.21 per 1 000 in-patient days) [ 22 ] and by the International Nosocomial Infection Control Consortium (4.8 per 1 000 catheter days) [ 23 ], our MC-CRBSI rate was higher.…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory surveillance was conducted in accordance with the Infectious Diseases Society of America’s and the Irish’s national CRI committee’s definitions [ 11 , 19 ]. Briefly, a microbiologically confirmed catheter-related bloodstream infection (MC-CRBSI) was defined as a bloodstream infection occurring within 48 h of catheter removal and the subsequent isolation of the same microorganism from the catheter culture as on the BC(s) [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, a microbiologically confirmed catheter-related bloodstream infection (MC-CRBSI) was defined as a bloodstream infection occurring within 48 h of catheter removal and the subsequent isolation of the same microorganism from the catheter culture as on the BC(s) [ 11 ]. Additional criteria were added to include events caused by common commensals, such as Staphylococcus epidermidis , in which only a single BC bottle flagged positive [ 19 ]. The genetic relationship between catheter tip and BC isolates of common commensals were confirmed with pulsed-field gel electrophoresis.…”

Section: Methodsmentioning

confidence: 99%

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Surveillance of catheter-related infections: the supplementary role of the microbiology laboratory

et al. 2015

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BackgroundThe burden of catheter-related infections (CRIs) in developing countries is severe. In South Africa, a standardised surveillance definition does not exist and the collection of catheter days is challenging. The aim of the study was to provide baseline data on the prevalence of CRIs and to describe the epidemiology of CRI events within a tertiary academic hospital.MethodsSurveillance was laboratory-based and conducted for a six month period. A microbiologically confirmed CRBSI (MC-CRBSI) event was defined as the isolation of the same microorganism from the catheter and concomitant blood cultures (BCs), within 48 h of catheter removal, which were not related to an infection at another site.ResultsA total of 508 catheters, removed from 332 patients, were processed by the laboratory, of which only 50% (253/508 removed from 143/332 patients) of the catheters were accompanied by BCs within 48 h. Sixty-five episodes of MC-CRBSI in 57 patients were detected, involving 71 catheters and 195 microbial isolates. The institutional prevalence rate was 3.7 episodes per 1 000 admissions and 5.8 episodes per 10 000 in-patient days. Catheter day data was collected in only six wards of the hospital. The pooled laboratory incidence was 10.1 MC-CRBSI episodes per 1 000 catheter days, whereas the hospital-based central line-associated bloodstream infection (CLABSI) rate was pooled at 5.7 episodes per 1 000 catheter days. The majority of patients had an underlying gastro-intestinal condition (33%; 19/56) with a non-tunnelled, triple-lumen central venous catheter, placed in the subclavian vein (38%; 27/71). The most predominant pathogen was methicillin-resistant Staphylococcus epidermidis (28%; 55/195), followed by extensively-drug resistant Acinetobacter baumannii (18%; 35/195).ConclusionsCatheter-related infection prevention and control efforts require urgent attention, not only to keep patients safe from preventable harm, but to prevent the spread of multidrug resistant microorganisms.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Surveillance of catheter-related infections: the supplementary role of the microbiology laboratory

et al. 2015

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“…Routine analysis was performed as requested by a medical practitioner on the laboratory requisition form and according to sample type. A S. epidermidis CRBSI was defined as the simultaneous isolation of the bacterium from an IVC and one or more BCs, which were submitted for culture within 48 h of each other (Mermel et al, 2009 ; Conrick-Martin et al, 2013 ). Even though a single positive BC yielding S. epidermidis was likely to present contamination, we included these samples due to the lack of local BC practices.…”

Section: Methodsmentioning

confidence: 99%

Molecular Epidemiology of Staphylococcus epidermidis Implicated in Catheter-Related Bloodstream Infections at an Academic Hospital in Pretoria, South Africa

et al. 2018

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Staphylococcus epidermidis is one of the most prevalent pathogens implicated in catheter-related bloodstream infections (CRBSI) at an academic hospital in Pretoria, South Africa. Little is known about the clonality and the prevalence of antibiotic resistance and virulence genes in S. epidermidis (e.g., icaAB, IS256, mecA, and qacA/B). A total of 508 intravascular catheters (IVCs) from 331 patients were submitted for culture from May to October 2013. Only 50% (n = 253/508) of the IVCs were accompanied by blood cultures (BCs) taken within 48 h. Forty-four percent (44%; n = 112/253) of IVCs were colonised, of which 26% (n = 65/253) were associated with a CRBSI. We identified S. epidermidis as the causal agent in 31% (n = 20/65) of the CRBSI cases. Fifty-nine S. epidermidis isolates were obtained, 23 isolates were cultured from 22 IVCs and 36 isolates were cultured from 36 BCs. All S. epidermidis isolates were resistant to β-lactams (100%; n = 59/59), followed by high levels of resistance toward erythromycin (86%; n = 51/59) and gentamicin (81%; n = 49/59). The mecA gene was prevalent in all the (100%, n = 59/59) isolates. Isolates contained the IS256 element (83%, n = 49/59), the icaAB gene (81%, n = 48/59) and, the qacA/B gene (81%, n = 48/59). All 48 isolates were qacA positive upon restriction enzyme digestion of the qacA/B amplicons. Phenotypic resistance toward 0.5% (m/v) chlorhexidine was not observed. Staphylococcal Cassette Chromosome (SCC) mec typing showed that SCCmec type IV (31%; n = 18/59) was the most prevalent. The remaining SCCmec elements were highly diverse. Pulsed-field gel electrophoresis (PFGE) showed that S. epidermidis isolates from individual patients were mostly clonal. Multilocus sequencing typing (MLST) of 10 sequenced isolates showed that sequence type (ST) 2 (40%; n = 4/10) was the most frequently detected, followed by ST54 (20%; n = 2/10), ST28 (10%; n = 1/10), ST59 (10%; n = 1/10) and ST490 (10%; 1/10). One isolate was newly assigned to ST596. These S. epidermidis infections can be attributed to patients' skin microflora or to poor infection control practices. Currently, S. epidermidis strains circulating in the studied hospital are multidrug-resistant and highly adaptive to environmental changes.

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“…The most recent studies that have reported improvements in CLABSI rates have drawn their comparisons from data before and after specific interventions and have primarily targeted patients of the ICU. 13 14 15 16 17 18 19 20 In the studies that have included patients who were not from the ICU, only certain parts of the central line (CL) bundle had been included in the reported analyses. 21 22 23 To address these limitations, we evaluated CLABSIs according to the rates of completion of CL bundle components, rather than performing a comparison of rates before and after the intervention.…”

Section: Introductionmentioning

confidence: 99%

Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections

et al. 2018

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PurposeThe present study aimed to evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) in different departments of the same hospital, including the intensive care unit (ICU) and other departments.Materials and MethodsThe four components of the CL bundle were hand hygiene, use of maximal sterile barrier precautions, chlorhexidine use, and selection of an appropriate site for venous access. Compliance of the CL bundle and CLABSIs were measured for every department [emergency room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patients were included over 3 years (August 2013 through July 2016).ResultsA total of 29 CLABSI episodes (1.73%) were identified, and only 53.7% of the patients completed CL bundles. The performance rates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6% for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients of the ICU, for whom all components were not performed perfectly. Conversely, the lowest CLABSI rate was observed for patients of GWs, for whom all components were performed. Among individual components, femoral insertion site [relative risk (RR), 2.26; 95% confidence interval (CI), 1.09–4.68], not using a full body drape (RR, 3.55; 95% CI, 1.44–8.71), and not performing all CL bundle components (RR, 2.79; 95% CI, 1.19–6.54) were significant variables associated with CLABSIs.ConclusionThis study provides direct evidence that completing all CL bundle components perfectly is essential for preventing CLABSIs. Customized education should be provided, according to specific weaknesses of bundle performance.

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Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance study

Cited by 7 publications

References 17 publications

Surveillance of catheter-related infections: the supplementary role of the microbiology laboratory

Surveillance of catheter-related infections: the supplementary role of the microbiology laboratory

Molecular Epidemiology of Staphylococcus epidermidis Implicated in Catheter-Related Bloodstream Infections at an Academic Hospital in Pretoria, South Africa

Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections

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