Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Abstract

BackgroundBlood cultures (BCs) are the gold standard for diagnosing sepsis and are prerequisite for a targeted antibiotic treatment and essential for patient outcomes. Aim of the study was to analyze the frequency of BCs, the rate of central line-associated bloodstream infections (CLABSIs) and to study the association between both parameters on intensive care units in Germany over time.MethodsCross-sectional studies at two points in time (2006, 2015) on ICUs participating in the German hospital infection surveillance system. CLABSIs were defined according to the Center for Disease Control and Prevention (CDC). Univariable and multivariable analyses were performed using generalized linear models.ResultsA total of 639 ICUs participated in 2006 or 2015 and 90 ICUs (“core group”) in both years. Overall, 2,427,921 patient days from 644,575 patients were analyzed. In the ICU core group the frequency of BCs per 1000 patient days doubled from 57.8 (interquartile range [IQR] 29.8–101.2; 2006) to 128.2 (IQR 71.6–183.2; 2015). In the same time, the pooled median CLABSI rate decreased from 0.8 (IQR 0–1.9; 2006) per 1000 central-line catheter days to 0.2 (IQR 0–0.9; 2015).ConclusionsFrom 2006 to 2015 the frequency of BCs increased on ICUs in Germany and is now within the recommended 100 to 200 BCs sets per 1000 patient days.

Limited indirect effects of an infant pneumococcal vaccination program in an aging population

“…A capture-recapture surveillance system for IPD in children has been in place in Germany since 1997, and indicence estimates produced by this system support that, since 2007, more than half of IPD cases in Germany have been reported, which is consistent with a GNRCS audit for adult IPD cases [29, 34]. Blood culture practices in Germany have also changed over the course of the study, with approximately twice as many occurring in ICUs in 2015 as did in 2006 [35]. Obviously, a demographic shift towards an older population may also result in increased rates of IPD, and indeed, the sample distribution of the GNRCS collection has shown an increase in the proportion of samples originating from IPD cases in adults over 80 and over 90 years old over the study period, however, the population at risk for IPD is therefore more vulnerable than previous estimates may have indicated.…”

Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle

“…Our addition of interventions beyond those recommended by the CDC may have led to one of the lowest CLABSI rates (0.36 per 1000 CVC days) reported in the literature to date. Salm et al (2018) and Ong et al (2011) reported modestly lower CLABSI rates, 0.2 and 0.3 per 1000 CVC days, respectively. Others have reported CLABSI rates ranging from 0.50 to 10 per 1000 CVC days (Han et al, 2010;Patel et al, 2018;Son et al, 2012).…”

Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central‐line associated blood stream infection and colonization in critically ill pediatric patients: A randomized controlled trial

“…Despite enabling reliable and safe vascular access in critically ill patients, these devices are associated with central line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) [4][5][6]. The frequency of CLABSI/CRBSI is reported to range from 0.20 to 17.6 per 1000 catheter days, and have been associated with age, catheter type, insertion site, indications, indwelling time, and underlying disease [7][8][9][10]. Higher incidence of CLABSI/CRBSI development increases antibiotic use, prolongs length of hospital stay and raises healthcare expense, as well as causing high mortality and morbidity [11][12][13].…”