Current Definitions of Central Line–Associated Bloodstream Infection Is the Emperor Wearing Clothes?

Sexton, Daniel J.; Chen, Luke F.; Anderson, Deverick J.

doi:10.1086/657583

Cited by 58 publications

(49 citation statements)

References 18 publications

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“…This may lead to false exclusion of real infections, for example, due to viridans streptococci in patients with severe chemotherapy-induced mucositis [17,39]. In the Oncoped 2006 module, a consensus between the infection preventionist and the attending paediatric oncology consultant is required on the question of whether a single positive blood culture represents a contamination or an infection and to which category (CVAD-associated or CVAD-related) the infection should be assigned [45]. Some experts have recently suggested to invent a new category for those BSIs in which pathogens (as E. coli or viridians streptococci) translocate from the inflamed mucous membranes of the oral cavity or the lower gastrointestinal tract in patients with severe mucositis [24,26,44].…”

Section: Discussionmentioning

confidence: 99%

Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

Ammann

Schrey

et al. 2015

Eur J Pediatr

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• Paediatric cancer patients face an increased risk of nosocomial bloodstream infections (BSIs). • In most cases, these BSIs are associated with the use of a long-term central venous catheter (Broviac, Port), severe and prolonged immunosuppression (e.g. neutropenia) and other chemotherapy-induced alterations of host defence mechanisms (e.g. mucositis). What is New: • This study is the first multicentre study confirming relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. • It describes the epidemiology of nosocomial BSI in paediatric cancer patients mainly outside the stem cell transplantation setting during conventional intensive therapy and argues for prospective surveillance programmes to target and evaluate preventive bundle interventions.

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Section: Discussionmentioning

confidence: 99%

Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

Ammann

Schrey

et al. 2015

Eur J Pediatr

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“…Another possibility for the observed change is less frequent reporting of CLABSIs associated with certain pathogens because of suboptimal implementation of case-finding and reporting methodology. 11 Participation in NHSN during the time period covered in this report was a combination of voluntary and mandatory reporting; participation in NHSN related to the CMS Hospital Inpatient Quality Reporting Program was not in effect until 2011 for CLABSIs among critical care patients and 2012 for CAUTIs or SSIs among patients undergoing abdominal hysterectomies or colon surgery. As reporting becomes more comprehensive across the United States, tracking the degree of spread of these and other emerging resistant pathogens will improve and will allow more accurate assessments of how widespread any one resistant phenotype is and how successful facilities and states have been in curtailing or reversing the spread of specific phenotypes across hospitals in the United States.…”

Section: Percent Resistancementioning

confidence: 99%

Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010

Sievert

Ricks

Edwards

et al. 2013

Infect. Control Hosp. Epidemiol.

1,402

1,041

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Objective.To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) during 2009-2010.Methods.Central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections were included. Pooled mean proportions of isolates interpreted as resistant (or, in some cases, nonsusceptible) to selected antimicrobial agents were calculated by type of HAI and compared to historical data.Results.Overall, 2,039 hospitals reported 1 or more HAIs; 1,749 (86%) were general acute care hospitals, and 1,143 (56%) had fewer than 200 beds. There were 69,475 HAIs and 81,139 pathogens reported. Eight pathogen groups accounted for about 80% of reported pathogens: Staphylococcus aureus (16%), Enterococcus spp. (14%), Escherichia coli (12%), coagulase-negative staphylococci (11%), Candida spp. (9%), Klebsiella pneumoniae (and Klebsiella oxytoca; 8%), Pseudomonas aeruginosa (8%), and Enterobacter spp. (5%). The percentage of resistance was similar to that reported in the previous 2-year period, with a slight decrease in the percentage of S. aureus resistant to oxacillins (MRSA). Nearly 20% of pathogens reported from all HAIs were the following multidrug-resistant phenotypes: MRSA (8.5%); vancomycin-resistant Enterococcus (3%); extended-spectrum cephalosporin-resistant K. pneumoniae and K. oxytoca (2%), E. coli (2%), and Enterobacter spp. (2%); and carbapenem-resistant P. aeruginosa (2%), K. pneumoniae/oxytoca (<1%), E, coli (<1%), and Enterobacter spp. (<1%). Among facilities reporting HAIs with 1 of the above gram-negative bacteria, 20%-40% reported at least 1 with the resistant phenotype.Conclusion.While the proportion of resistant isolates did not substantially change from that in the previous 2 years, multidrug-resistant gram-negative phenotypes were reported from a moderate proportion of facilities.

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“…In particular, the surveillance definition of CLABSI, including all bloodstream infections without a known primary source occurring in patients with central lines, lacks specificity, particularly in patients with chemotherapy-induced neutropenia who are predisposed to translocation of intestinal organisms. 24 This study was conducted before the CDC developed a modification of the surveillance CLABSI definition to account for patients with mucosal barrier injury and neutropenia. 27 We compensated for the lack of specificity of the contemporary surveillance CLABSI definition in patients with neutropenia by excluding those patients from the numerator in a sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Silver-Coated Needleless Connector and a Standard Needleless Connector for the Prevention of Central Line-Associated Bloodstream Infections

Jacob

Tejedor

Reyes

et al. 2014

Infect. Control Hosp. Epidemiol.

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objective. To assess the impact of a novel, silver-coated needleless connectors (NCs) on central-line-associated bloodstream infection (CLABSI) rates compared with a mechanically identical NCs without a silver coating. conclusions. The use of silver-coated NCs decreased the CLABSI rate by 32%. CLABSI reduction efforts should include efforts to minimize contamination of NCs. Infect Control Hosp Epidemiol 2015;36(3):294-301Central-line-associated bloodstream infection (CLABSI) is a major cause of patient harm, and prevention of such infections has received much attention over the past decade. A national effort to prevent CLABSIs has been undertaken through optimization of central-line insertion practices. With this and other strategies, including economic disincentives through payment reform and public reporting of infection rates, the incidence of CLABSI has decreased in U.S. hospitals; however, in 2009,~41,000 CLABSIs were reported. 1 The persistence of CLABSIs and their high associated mortality underscore the need for novel prevention efforts.CLABSIs occur through two major routes. Infection can occur via an extraluminal pathway when microorganisms, often from the skin surface, gain access to the bloodstream via the external catheter surface. This contamination of the catheter surface can occur at the time of catheter insertion, particularly if proper insertion practices are not used. Intraluminal colonization of the catheter with seeding of the bloodstream typically occurs following contamination of the catheter hub, which is frequently manipulated in the process of injecting medications or fluids. Molecular typing of blood, skin, and catheter hub isolates suggests that most CLABSIs occurring early after line insertion originate from the skin (and are likely insertion-related events), whereas many CLABSIs occurring after the first 1-2 weeks of line placement are related to catheter hub contamination. [2][3][4][5][6][7][8]

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Current Definitions of Central Line–Associated Bloodstream Infection Is the Emperor Wearing Clothes?

Cited by 58 publications

References 18 publications

Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010

Comparison of a Silver-Coated Needleless Connector and a Standard Needleless Connector for the Prevention of Central Line-Associated Bloodstream Infections

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