Non-ICU nosocomial vascular catheter-related bloodstream infections

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Nosocomial CRBSIs outside ICUs are associated with high mortality risk, particularly among patients with a higher Charlson score and bloodstream infections caused by Staphylococcus. aureus and Candida species” Saliba et al (2017).

Abstract:

BACKGROUND: Vascular catheter-related bloodstream infections (CRBSIs) are highly preventable hospital-acquired infections and a major threat to patient safety. While there is significant information regarding CRBSI outcome among Intensive Care Unit (ICU) patients, data regarding non-ICU patients are scarce.

AIM: To determine the risk factors associated with 30-day mortality among non-ICU patients with nosocomial CRBSIs.

METHODS: Prospective cohort study of non-ICU patients with nosocomial CRBSIs in a tertiary-care centre, between January 2004 and December 2014.

PRIMARY OUTCOME: 30-day mortality, defined as death from any cause within 30 days of CRBSI.

FOLLOW-UP: 30-days from CRBSI onset. Time until death was the dependent variable in Cox regression analysis.

FINDINGS: A total of 546 cases of CRBSIs were identified; mean age: 64.5 years (IQR:55-75), male: 66%, and mean Charlson score: 3.59 (IQR:2-5). Of these, 58.4% resulted from central venous catheters and 41.6%, from peripheral venous catheters. The causative agents were Gram-positive cocci (70.1% of cases), Gram-negative bacilli (31.1%), and Candida species (1%). Mortality within 30 days was 13.9%, with no significant changes over the study period. Independent risk factors for 30-day mortality were Charlson score ≥4 (HR:1.80;95%CI:1.19-2.73), Staphylococcus aureus infection (HR:2.67;95%CI:1.61-4.43), and Candida species infection (HR:6.1;95%CI:2.08-18.04); whilst age, area of admission, and type, use and site of vascular catheter, and administration of appropriate empirical antibiotic treatment were not.

CONCLUSION: Nosocomial CRBSIs outside ICUs are associated with high mortality risk, particularly among patients with a higher Charlson score and bloodstream infections caused by Staphylococcus. aureus and Candida species.

Reference:

Saliba, P., Hornero, A., Cuervo, G., Grau, I., Jimenez, E., García, D., Tubau, F., Martínez-Sánchez, J.M., Carratalà, J. and Pujol, M. (2017) Mortality risk factors among non-ICU patients with nosocomial vascular catheter-related bloodstream infections: a prospective cohort study. The Journal of Hospital Infection. November 8th. [epub ahead of print].

doi: 10.1016/j.jhin.2017.11.002.

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