We describe central line-associated bloodstream infection (CLABSI) pathogens and antimicrobial resistance patterns reported from oncology locations to the CDC’s National Healthcare Safety Network (NHSN)” See et al (2016).
BACKGROUND: Recent antimicrobial resistance data are lacking from inpatient oncology settings to guide infection prophylaxis and treatment recommendations. We describe central line-associated bloodstream infection (CLABSI) pathogens and antimicrobial resistance patterns reported from oncology locations to the CDC’s National Healthcare Safety Network (NHSN).
METHODS: CLABSI data reported to NHSN from 2009-2012 from adult inpatient oncology locations were compared to data from non-oncology adult locations within the same hospitals. Pathogen profile, antimicrobial resistance rates, and CLABSI incidence rates/per 1000 central line-days were calculated. CLABSI incidence rates were compared using Poisson regression.
RESULTS: During 2009-2012, 4654 CLABSIs were reported to NHSN from 299 adult oncology units. The most common organisms causing CLABSI in oncology locations were coagulase-negative staphylococci (16.9%), Escherichia coli (11.8%), and Enterococcus faecium (11.4%). Fluoroquinolone resistance was more common among E. coli CLABSI in oncology than non-oncology locations (56.5% vs 41.5% of isolates tested, P<0.0001) and increased significantly from 2009-2010 to 2011-2012 (49.5% vs 60.4%, P=0.01). Furthermore, rates of CLABSI were significantly higher in oncology compared to non-oncology locations for fluoroquinolone-resistant E. coli (rate ratio: 7.37, 95% confidence interval, 6.20-8.76) and vancomycin-resistant E. faecium (rate ratio: 2.27, 95% confidence interval, 2.03-2.53). However, resistance rates for some organisms, such as Klebsiella spp. and Pseudomonas aeruginosa, were lower in oncology than in non-oncology locations.
CONCLUSIONS: Antimicrobial-resistant E. coli and E. faecium have become significant pathogens in oncology. Practices for antimicrobial prophylaxis and empiric antimicrobial therapy should be regularly assessed in conjunction with contemporary antimicrobial resistance data.
See, I., Freifeld, A.G. and Magill, S.S. (2016) Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated Central Line-Associated Bloodstream Infections from Oncology Settings, 2009-2012. Clinical Infectious Diseases. March 1st. .
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