Catheter-related infections: does the spectrum of microbial causes change over time? A nationwide surveillance study

BMJ Open. 2018 Dec 22;8(12):e023824. doi: 10.1136/bmjopen-2018-023824.

Abstract

Objectives: To estimate the incidence and epidemiology of catheter-related bloodstream infections (CRBSIs) on a national scale by using prospective epidemiological data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS).

Design: Observational study.

Setting: National surveillance from 2008 to 2015 of acute hospitals in Switzerland.

Participants: We included acute Swiss hospitals that sent blood cultures and catheter tip culture results on a regular basis during the entire study period to the ANRESIS database.

Outcome measure: A catheter-related bloodstream infection (termed 'modified CRBSI', mCRBSI) was defined as isolating the same microorganism with identical antibiogram from ≥1 blood cultures (performed ±7 days around the catheter removal) as the one recovered from the catheter tip. Incidence rates of mCRBSI were calculated per 1000 admissions.

Results: From 2008 to 2015, the mCRBSI incidence rate decreased from 0.83 to 0.58 episodes/1000 admissions (-6% per year, p<0.001). Coagulase-negative staphylococci, Staphylococcus aureus and fungi all exhibited decreasing trends, while rates of enterococci and Gram-negative bacteria remained stable.

Conclusions: The overall incidence of mCRBSI in Switzerland is decreasing; however, the incidence of mCRBSI due to Enterococci and Gram-negative micro-organisms did not change over time. These pathogens may grow in importance in catheter-related infections, which would have clinical implications for the choice of empirical treatment.

Keywords: CLABSI; CRBSI; bloodstream infections; catheter infection; catheter tip; trends.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Bacteremia / epidemiology*
  • Bacteremia / microbiology*
  • Catheter-Related Infections / diagnosis
  • Catheter-Related Infections / drug therapy
  • Catheter-Related Infections / epidemiology*
  • Catheter-Related Infections / microbiology*
  • Catheterization, Central Venous / adverse effects
  • Catheters, Indwelling / adverse effects
  • Catheters, Indwelling / microbiology
  • Databases, Factual
  • Drug Resistance, Microbial
  • Female
  • Hospitals, University
  • Humans
  • Incidence
  • Male
  • Microbial Sensitivity Tests*
  • Poisson Distribution
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Switzerland / epidemiology