Journal of Hospital Infection 85 (2013) 316e320 Available online at www.sciencedirect.com
Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin
Short report
Catheter-related bloodstream infections caused by Gram-negative bacteria ´ndez Cruz a, b, c, E. Reigadas a, b, c, E. Bouza a, b, c, d, A. Eworo a, b, c, A. Ferna ˜oz a, b, c, d, * ´ixems a, b, c, d, P. Mun M. Rodrı´guez-Cre a
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Maran˜o´n, Madrid, Spain Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain c Instituto de Investigacio´n Sanitaria Gregorio Maran˜o´n, Madrid, Spain d CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain b
A R T I C L E
I N F O
Article history: Received 2 April 2013 Accepted 4 August 2013 Available online 18 September 2013 Keywords: Blood cultures Catheter-related bloodstream infection Catheter-related infections Gram-negative bacteria Vascular catheter
S U M M A R Y
From 2008 to 2010, patients with microbiologically confirmed Gram-negative catheterrelated bloodstream infection (GN-CRBSI) were each compared with two randomly selected controls. We included 81 cases (17% of all CRBSI) and 162 controls with CRBSI caused by other pathogens. Incidence of GN-CRBSI was 0.53 episodes per 1000 admissions. Cases were more likely to have underlying neurological disease or gastrointestinal conditions, previous antimicrobial therapy and a shorter time to blood culture positivity. Surgery in the present admission (odds ratio: 3.5), P. aeruginosa (3.6) and a complicated bacteraemia (4.1) were related to a higher mortality rate. GN-CRBSI accounts for 17% of all CRBSI and should be taken into consideration in the empirical therapy of patients with the characteristics mentioned above. ª 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Introduction Information regarding secular trends in the incidence and aetiology of catheter-related bloodstream infection (CRBSI) in large teaching institutions is very limited.1 We and others have observed a significant reduction in the incidence of CRBSI among patients admitted to adult intensive care units (ICUs), but not in other hospital areas. In addition, recent data from our institution suggest a decrease in episodes caused by Staphylococcus aureus, whereas CRBSI due to
* Corresponding author. Address: Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Maran ˜o ´n, Dr. Esquerdo 46. 28007 Madrid, Spain. Tel.: þ34 91-5868453; fax: þ34 91-5044906. E-mail address: [email protected] (P. Mun ˜oz).
Enterococcus spp., fungi and Gram-negative bacteria has increased.2 We performed a retrospective cohort analysis of all patients with microbiologically confirmed Gram-negative (GN-CRBSI). Our aims were to describe the epidemiology, clinical characteristics, risk factors, management and outcome of GN-CRBSI.
Methods Our hospital is a general teaching institution with 1550 beds serving a population of 715,000 inhabitants. During the study period (January 2008 to December 2010) the average admission rate per year was 55,764. Our institution conducts active policies for the prevention of CRBSI, according to standard guidelines.3 A retrospective caseecontrol study was performed including patients admitted to the hospital. All blood and catheter
0195-6701/$ e see front matter ª 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jhin.2013.08.008
E. Bouza et al. / Journal of Hospital Infection 85 (2013) 316e320 samples from intravenous lines, sent for bacterial and fungal culture to our laboratory during the study period, were included. Cases were defined as patients with proven GN-CRBSI (the same micro-organism isolated from blood and a catheter tip within a 1-week period) and controls as patients with CRBSI caused by non-Gram-negative micro-organisms. Two controls were randomly selected from the microbiology laboratory database for each case according to the following age groups: adults (>18 years), paediatric patients (1 month to 18 years), and neonatal population (
Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin
Short report
Catheter-related bloodstream infections caused by Gram-negative bacteria ´ndez Cruz a, b, c, E. Reigadas a, b, c, E. Bouza a, b, c, d, A. Eworo a, b, c, A. Ferna ˜oz a, b, c, d, * ´ixems a, b, c, d, P. Mun M. Rodrı´guez-Cre a
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Maran˜o´n, Madrid, Spain Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain c Instituto de Investigacio´n Sanitaria Gregorio Maran˜o´n, Madrid, Spain d CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain b
A R T I C L E
I N F O
Article history: Received 2 April 2013 Accepted 4 August 2013 Available online 18 September 2013 Keywords: Blood cultures Catheter-related bloodstream infection Catheter-related infections Gram-negative bacteria Vascular catheter
S U M M A R Y
From 2008 to 2010, patients with microbiologically confirmed Gram-negative catheterrelated bloodstream infection (GN-CRBSI) were each compared with two randomly selected controls. We included 81 cases (17% of all CRBSI) and 162 controls with CRBSI caused by other pathogens. Incidence of GN-CRBSI was 0.53 episodes per 1000 admissions. Cases were more likely to have underlying neurological disease or gastrointestinal conditions, previous antimicrobial therapy and a shorter time to blood culture positivity. Surgery in the present admission (odds ratio: 3.5), P. aeruginosa (3.6) and a complicated bacteraemia (4.1) were related to a higher mortality rate. GN-CRBSI accounts for 17% of all CRBSI and should be taken into consideration in the empirical therapy of patients with the characteristics mentioned above. ª 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Introduction Information regarding secular trends in the incidence and aetiology of catheter-related bloodstream infection (CRBSI) in large teaching institutions is very limited.1 We and others have observed a significant reduction in the incidence of CRBSI among patients admitted to adult intensive care units (ICUs), but not in other hospital areas. In addition, recent data from our institution suggest a decrease in episodes caused by Staphylococcus aureus, whereas CRBSI due to
* Corresponding author. Address: Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Maran ˜o ´n, Dr. Esquerdo 46. 28007 Madrid, Spain. Tel.: þ34 91-5868453; fax: þ34 91-5044906. E-mail address: [email protected] (P. Mun ˜oz).
Enterococcus spp., fungi and Gram-negative bacteria has increased.2 We performed a retrospective cohort analysis of all patients with microbiologically confirmed Gram-negative (GN-CRBSI). Our aims were to describe the epidemiology, clinical characteristics, risk factors, management and outcome of GN-CRBSI.
Methods Our hospital is a general teaching institution with 1550 beds serving a population of 715,000 inhabitants. During the study period (January 2008 to December 2010) the average admission rate per year was 55,764. Our institution conducts active policies for the prevention of CRBSI, according to standard guidelines.3 A retrospective caseecontrol study was performed including patients admitted to the hospital. All blood and catheter
0195-6701/$ e see front matter ª 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jhin.2013.08.008
E. Bouza et al. / Journal of Hospital Infection 85 (2013) 316e320 samples from intravenous lines, sent for bacterial and fungal culture to our laboratory during the study period, were included. Cases were defined as patients with proven GN-CRBSI (the same micro-organism isolated from blood and a catheter tip within a 1-week period) and controls as patients with CRBSI caused by non-Gram-negative micro-organisms. Two controls were randomly selected from the microbiology laboratory database for each case according to the following age groups: adults (>18 years), paediatric patients (1 month to 18 years), and neonatal population (
