Central Line–Associated Bloodstream Infections in Adult Hematology Patients with Febrile Neutropenia An Evaluation of Surveillance Definitions Using Differential Time to Blood Culture Positivity

Abstract

We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line–associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis

“…[25][26][27] With retrospective application of the new NHSN definitions, 1 study at a large teaching hospital in San Diego was able to demonstrate that exclusion of BSI attributable to MBI resulted in a 15% reduction in reported 5-year CLABSI rates, 28 thereby supporting previous studies that suggested overestimation of CLABSI rates within neutropenic populations. 29 In our study, the high prevalence of neutropenic patients with hematologic malignancy may be represented by the large percentage of enteric organisms recovered; however, Staphylococcus spp. still represented a significant proportion of organisms (25%), suggesting that neutropenia-related translocation risk may occur in conjunction with, rather than in place of, baseline central-line-related factors.…”

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…Some patients with CVCs experience BSIs that do not arise from the catheter, but rather originate from translocation of bacteria through non-intact oral and gut mucosa. 9,10 To address this type of BSI, the Centers for Disease Control and Prevention defined a specific CLABSI type known as 'mucosal barrier injury laboratory-confirmed bloodstream infection' (MBI-LCBI) based on literature review and expert opinion. In 2013, the MBI-LCBI definition was integrated into NHSN methods for primary BSI surveillance to identify a subset of BSIs reported as CLABSIs that were likely related to mucosal barrier injury in the mouth and gut and not the presence of the CVC itself.…”

Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI): Descriptive Analysis of Data Reported to National Healthcare Safety Network (NHSN), 2013

“…17 Therefore, optimizing central-line insertion and maintenance practices will not address some MBI-LCBIs in these settings, and additional efforts to develop and implement prevention strategies for these BSIs are needed to prevent patient morbidity. 6,7,16 Removing MBI-LCBI events from calculated CLABSI rates had only a small effect on overall rates. However, among locations that reported MBI-LCBI events, removing MBI-LCBI events decreased CLABSI rates by 45%, a proportion similar to the decrease in oncology locations.…”