A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center
Department of Medicine, Division of Infectious Diseases and Immunology; Department of Anesthesiology and Perioperative Medicine; Department of Pathology; Department of Microbiology and Physiological Systems
Bacterial Infections and Mycoses | Critical Care | Immunology and Infectious Disease | Infectious Disease
BACKGROUND: The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center.
METHODS: This was a retrospective analysis of all positive-result blood cultures among patients admitted to seven adult ICUs for fiscal year 2005 (FY2005) through FY2014 according to Centers for Disease Control and Prevention National Healthcare Safety Network definitions. The rate of change for primary and secondary hospital-onset BSIs was determined, as was the distribution of organisms responsible for these BSIs. Data from three medical, two general surgical, one combined neurosurgical/trauma, and one cardiac/cardiac surgery adult ICU were analyzed.
RESULTS: Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1,000 patient days in FY2005 to 0.32/1,000 patient days in FY2014; an 85.0% decrease (P < .0001). Secondary BSIs also progressively decreased from 3.56/1,000 to 0.66/1,000 patient days; an 81.4% decrease (P < .0001). The decrease in BSI rates remained significant after controlling for the number of blood cultures obtained and patient acuity.
CONCLUSIONS: An increased focus on reducing hospital-onset infections at the academic medical center since 2005, including multimodal multidisciplinary efforts to prevent central line-associated BSIs, pneumonia, Clostridium difficile disease, surgical site infections, and urinary tract infections, was associated with progressive and sustained decreases for both primary and secondary hospital-onset BSIs.
bacteremia, bloodstream infection, central line-associated bloodstream infection, hospital-onset bacteremia, ICU, nosocomial
DOI of Published Version
Civitarese AM, Ruggieri E, Walz JM, Mack DA, Heard SO, Mitchell M, Lilly CM, Landry KE, Ellison RT 3rd. A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center. Chest. 2017 May;151(5):1011-1017. doi: 10.1016/j.chest.2017.02.008. Epub 2017 Feb 17. PMID: 28215789. Link to article on publisher's site
Civitarese AM, Ruggieri E, Walz JM, Mack D, Heard SO, Mitchell M, Lilly CM, Landry K, Ellison RT. (2017). A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center. Infectious Diseases and Immunology Publications. https://doi.org/10.1016/j.chest.2017.02.008. Retrieved from https://escholarship.umassmed.edu/infdis_pp/403