Pathogens causing central-line–associated bloodstream infections in acute-care hospitals—United States, 2011–2017

Novosad, Shannon; Fike, Lucy; Dudeck, Margaret A.; Allen-Bridson, Katherine; Edwards, Jonathan R.; Edens, Chris; Sinkowitz‐Cochran, Ronda L.; Powell, Krista; Kuhar, David T.

doi:10.1017/ice.2019.303

Cited by 52 publications

(36 citation statements)

References 29 publications

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“…In contrast, in the Safdar's study, 87% of microorganisms identified were CoNS. In this context, and consistently with our findings, a change in the epidemiology of intravascular catheter infection toward lower prevalence of CoNS and increasing proportion of Gram-negative microorganisms has been documented in several recent studies [12,13,35]. In light of these considerations, the description of this cohort may probably better represent this issue.…”

Section: Discussionsupporting

confidence: 88%

Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs

et al. 2020

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Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local sign, redness, pain, non-purulent discharge, and purulent discharge at removal were observed in 1938 (13.3%), 1633 (11.2%), 59 (0.4%), 251 (1.7%), and 102 (0.7%) episodes, respectively. After adjusting on confounders, ≥ 1 local sign, redness, non-purulent discharge, and purulent discharge were associated with CRBSI. The presence of ≥ 1 local sign increased the probability to observe CRBSI in the first 7 days of catheter maintenance (OR 6.30 vs. 2.61 [> 7 catheter-days], pheterogeneity = 0.02). Conclusions Local signs were significantly associated with CRBSI in the ICU. In the first 7 days of catheter maintenance, local signs increased the probability to observe CRBSI.

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Section: Discussionsupporting

confidence: 88%

Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs

et al. 2020

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“…Enterococcus faecium is commonly inhabiting the gut of animals and humans but has also emerged as a nosocomial pathogen causing a sizable fraction of healthcareassociated infections, specifically device-associated infections like central line-associated bloodstream and surgical site infections [1,2]. The intrinsic and acquired multi-drug resistance against fluoroquinolones, aminoglycosides, and more importantly against glycopeptides motivated the inclusion of E. faecium in the WHO global priority list [3].…”

Section: Introductionmentioning

confidence: 99%

Mode and dynamics of vanA-type vancomycin resistance dissemination in Dutch hospitals

et al. 2021

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Background Enterococcus faecium is a commensal of the gastrointestinal tract of animals and humans but also a causative agent of hospital-acquired infections. Resistance against glycopeptides and to vancomycin has motivated the inclusion of E. faecium in the WHO global priority list. Vancomycin resistance can be conferred by the vanA gene cluster on the transposon Tn1546, which is frequently present in plasmids. The vanA gene cluster can be disseminated clonally but also horizontally either by plasmid dissemination or by Tn1546 transposition between different genomic locations. Methods We performed a retrospective study of the genomic epidemiology of 309 vancomycin-resistant E. faecium (VRE) isolates across 32 Dutch hospitals (2012–2015). Genomic information regarding clonality and Tn1546 characterization was extracted using hierBAPS sequence clusters (SC) and TETyper, respectively. Plasmids were predicted using gplas in combination with a network approach based on shared k-mer content. Next, we conducted a pairwise comparison between isolates sharing a potential epidemiological link to elucidate whether clonal, plasmid, or Tn1546 spread accounted for vanA-type resistance dissemination. Results On average, we estimated that 59% of VRE cases with a potential epidemiological link were unrelated which was defined as VRE pairs with a distinct Tn1546 variant. Clonal dissemination accounted for 32% cases in which the same SC and Tn1546 variants were identified. Horizontal plasmid dissemination accounted for 7% of VRE cases, in which we observed VRE pairs belonging to a distinct SC but carrying an identical plasmid and Tn1546 variant. In 2% of cases, we observed the same Tn1546 variant in distinct SC and plasmid types which could be explained by mixed and consecutive events of clonal and plasmid dissemination. Conclusions In related VRE cases, the dissemination of the vanA gene cluster in Dutch hospitals between 2012 and 2015 was dominated by clonal spread. However, we also identified outbreak settings with high frequencies of plasmid dissemination in which the spread of resistance was mainly driven by horizontal gene transfer (HGT). This study demonstrates the feasibility of distinguishing between modes of dissemination with short-read data and provides a novel assessment to estimate the relative contribution of nested genomic elements in the dissemination of vanA-type resistance.

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“…Yeast-related BSI are usually healthcare-associated infections with a high mortality of up to 60% in critically ill patients [ 1 , 3 – 5 ]. Importantly, BSI caused by Candida spp., central-line-associated BSI in particular, have been increasing over the past decades [ 6 ]. The international EPIC II study including more than 14,000 patients showed that Candida was the third most common cause of infection and was second in both North America and Western Europe [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Schroeder

Weber

Denker

et al. 2020

Ann. Intensive Care

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Background Despite advances in the management of bloodstream infections (BSI) caused by Candida spp., the mortality still remains high in critically ill patients. The worldwide epidemiology of yeast-related BSI is subject to changing species distribution and resistance patterns, challenging antifungal treatment strategies. The aim of this single-center study was to identify predictors of mortality after 28 and 180 days in a cohort of mixed surgical and medical critically ill patients with candidemia. Methods Patients, who had been treated for laboratory-confirmed BSI caused by Candida spp. in one of 12 intensive care units (ICU) at a University hospital between 2008 and 2017, were retrospectively identified. We retrieved data including clinical characteristics, Candida species distribution, and antifungal management from electronic health records to identify risk factors for mortality at 28 and 180 days using a Cox regression model. Results A total of 391 patients had blood cultures positive for Candida spp. (incidence 4.8/1000 ICU admissions). The mortality rate after 28 days was 47% (n = 185) and increased to 60% (n = 234) after 180 days. Age (HR 1.02 [95% CI 1.01–1.03]), a history of liver cirrhosis (HR 1.54 [95% CI 1.07–2.20]), septic shock (HR 2.41 [95% CI 1.73–3.37]), the Sepsis-related Organ Failure Assessment score (HR 1.12 [95% CI 1.07–1.17]), Candida score (HR 1.25 [95% CI 1.11–1.40]), and the length of ICU stay at culture positivity (HR 1.01 [95% CI 1.00–1.01]) were significant risk factors for death at 180 days. Patients, who had abdominal surgery (HR 0.66 [95% CI 0.48–0.91]) and patients, who received adequate (HR 0.36 [95% CI 0.24–0.52]) or non-adequate (HR 0.31 [95% CI 0.16–0.62]) antifungal treatment, had a reduced mortality risk compared to medical admission and no antifungal treatment, respectively. Conclusions The mortality of critically ill patients with Candida BSI is high and is mainly determined by disease severity, multiorgan dysfunction, and antifungal management rather than species distribution and susceptibility. Our results underline the importance of timely treatment of candidemia. However, controversies remain on the optimal definition of adequate antifungal management.

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Pathogens causing central-line–associated bloodstream infections in acute-care hospitals—United States, 2011–2017

Cited by 52 publications

References 29 publications

Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs

Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs

Mode and dynamics of vanA-type vancomycin resistance dissemination in Dutch hospitals

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

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