The purpose of this study was to review central line-associated blood stream infection (CLABSI) data from a surgical trauma intensive care unit to better understand patient risk factors, pathogens, and treatment interventions. We performed a retrospective review of all surgical ICU patients who met the Centers for Disease Control definition for Gram-negative CLABSI from 2006 through 2013. Demographics, pathogens, interventions, and outcomes were evaluated. A total of 40 patients were included with an average age of 49.9 ± 19 years and 72.5 per cent male. The average length of central venous line (CVL) was 11 ± 5.9 days with average time from line placement to positive culture 9.4 ± 6.8 days. Most common organisms were Enterobacter species (37.5%) with 17.8 per cent of all cultured organisms considered multidrug resistant. Piperacillin–tazobactam (67.5%) was the most commonly used antibiotic. Overall mortality rate was 22.5 per cent. A total of 11 patients who developed a recurrence did so at 10.7 ± 8 days and were similar to those without recurrence. Predominant pathogens associated with surgical trauma intensive care unit CLABSI in this study are different from those Gram-negative bacteria associated with published studies in the general hospital population. Further investigation into risk factors for infection and relapse is important to minimize such consequences. Understanding appropriate line placement and use as well as clarifying optimal duration of therapy is integral in improving outcomes.
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References
1.
Centers for Medicare and Medicaid Services (CMS) HHS.Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.Fed Regist2013; 78: 50495–1040.
Centers for Medicare and Medicaid Services (CMS) HHS.Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.Fed Regist2014; 79: 49853–50536.
4.
MarcosM., SorianoA., IñurrietaA.Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens.J Antimicrob Chemother2011; 66: 2119–25.
5.
Casanova VivasS.[Recommendations from CDC for the prevention of catheter-related infections (2013 update)].Rev Enferm2014; 37: 28–33.
6.
KohnL., CorriganJ., DonaldsonM., MedicineIoTo err is human: Building a safer health system.Washington, DC: National Academy Press, 2000.
7.
RamanathanR., LeavellP., StockslagerG.Validity of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9–CM) screening for sepsis in surgical mortalities.Surg Infect (Larchmt)2014; 15: 513–6.
8.
RamanathanR., LeavellP., WolfeL.G.Agency for Healthcare Research and Quality patient safety indicators and mortality in surgical patients.Am Surg2014; 80: 801–4.
9.
MartinG.S., ManninoD.M.The epidemiology of sepsis in the United States from 1979 through 2000.N Engl J Med2003; 348: 1546–54.
10.
AngusD.C., Linde-ZwirbleW.T., LidickerJ.Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.Crit Care Med2001; 29: 1303–10.
11.
PronovostP.Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project.Am J Infect Control2008; 36(10): S171.e1–5.
12.
DuaneT.M., BrownH., BorchersC.T.A central venous line protocol decreases bloodstream infections and length of stay in a trauma intensive care unit population.Am Surg2009; 75: 1166–70.
13.
WatersT.M., DanielsM.J., BazzoliG.J.Effect of medicare's nonpayment for hospital-acquired conditions: Lessons for future policy.JAMA Intern Med2015; 175: 347–54.
ZinggW., SaxH., InanC.Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected.J Hosp Infect2009; 73: 41–6.
