Nosocomial Bloodstream Infections in Finnish Hospitals during 1999–2000

Abstract

Prospective laboratory-based surveillance in 4 Finnish hospitals during 1999-2000 identified 1477 cases of nosocomial bloodstream infection (BSI), with an overall rate of 0.8 BSIs per 1000 patient-days. Of BSI cases, 33% were in patients with a hematological malignancy and 15% were in patients with a solid malignancy; 26% were in patients who had undergone surgery preceding infection. Twenty-six percent of BSIs were related to intensive care, and 61% occurred in patients with a central venous catheter. Sixty-five percent of the 1621 causative organisms were gram positive, 31% were gram negative, and 4% were fungi. The most common pathogens were coagulase-negative staphylococci (31%), Escherichia coli (11%), Staphylococcus aureus (11%), and enterococci (6%). Methicillin resistance was detected in 1% of S. aureus isolates and vancomycin resistance in 1% of enterococci. The 7-day case-fatality ratio was 9% and was highest for infections caused by Candida (21%) and enterococci (18%). The overall rate of nosocomial BSIs was similar to rates in England and the United States, but S. aureus, enterococci, and fungi were less common in our study, and the prevalence of antibiotic resistance was lower.

What do central venous catheter‐associated bloodstream infections have to do with bundles?

“…In a study of patients admitted to the medical and surgical ICUs of a nonteaching hospital in Missouri, USA, investigators determined that 1% of all patients and 4% of patients with a CVC developed a primary BSI, for a rate of 4/1000 catheter-days (16 tertiary-care teaching hospitals. Comparable BSI rates have been reported from Finnish (0.8/1000 patient-days) (17) and Greek (3.6/1000 admissions) (18) studies.…”

“…The most common pathogens are Gram-positive organisms: coagulase-negative staphylococci, Staphylococcus aureus and enterococci (15)(16)(17)(18). While the relative frequencies of pathogens have remained fairly stable over the past decade, the continued increase in antimicrobial-resistant strains, especially methicillin-resistant S aureus, is of concern (14,15).…”

“…Crude mortality rates for nosocomial BSIs have ranged from 16% to 53%, varying with organism and patient acuity of illness (12,15,17,19,20). Studies have generally identified excess attributable mortality due to the presence of a nosocomial BSI.…”

Direct Identification of Gram-Positive Cocci from Routine Blood Cultures by Using AccuProbe Tests

“…Along with enterococci, S. aureus and coagulase-negative staphylococci are among the causes of blood culture-positive nosocomial infections, the rate of which has increased during the past decade (4,9). Our ROC analysis-based cutoff value adjustment improved the clinical usability of the S. aureus AccuProbe test, but the test still does not perform as well as the other AccuProbe tests.…”

“…In addition, a statistical antibiotic resistance pattern based on local data can be added to the report for guidance. Such a preliminary resistance pattern is indeed relevant, since the antibiotic resistance of the clinically most important bacteria, such as S. aureus, is still relatively stable in Finland (5,9). However, the final decision about antimicrobial therapy is always made in conjunction with the use of other laboratory and clinical data.…”