Proposing an Empirically Justified Reference Threshold for Blood Culture Sampling Rates in Intensive Care Units

Early and appropriate blood culture sampling is recommended as a standard of care for patients with suspected bloodstream infections (BSI) but is rarely taken into account when quality indicators for BSI are evaluated. To date, sampling of about 100 to 200 blood culture sets per 1,000 patient-days is recommended as the target range for blood culture rates. However, the empirical basis of this recommendation is not clear. The aim of the current study was to analyze the association between blood culture rates and observed BSI rates and to derive a reference threshold for blood culture rates in intensive care units (ICUs). This study is based on data from 223 ICUs taking part in the German hospital infection surveillance system. We applied locally weighted regression and segmented Poisson regression to assess the association between blood culture rates and BSI rates. Below 80 to 90 blood culture sets per 1,000 patient-days, observed BSI rates increased with increasing blood culture rates, while there was no further increase above this threshold. Segmented Poisson regression located the threshold at 87 (95% confidence interval, 54 to 120) blood culture sets per 1,000 patient-days. Only one-third of the investigated ICUs displayed blood culture rates above this threshold. We provided empirical justification for a blood culture target threshold in ICUs. In the majority of the studied ICUs, blood culture sampling rates were below this threshold. This suggests that a substantial fraction of BSI cases might remain undetected; reporting observed BSI rates as a quality indicator without sufficiently high blood culture rates might be misleading.

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The effect of the COVID-19 pandemic on the epidemiology of positive blood cultures in Swiss intensive care units: a nationwide surveillance study

Critical Care ◽

10.1186/s13054-021-03814-z ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Lauro Damonti ◽

Andreas Kronenberg ◽

Jonas Marschall ◽

Philipp Jent ◽

Rami Sommerstein ◽

...

Keyword(s):

Intensive Care ◽

Blood Culture ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Incidence Rates ◽

Blood Cultures ◽

Nationwide Surveillance ◽

The Impact ◽

Second Wave ◽

Interim Period

Abstract Background Evidence about the impact of the pandemic of COVID-19 on the incidence rates of blood cultures contaminations and bloodstream infections in intensive care units (ICUs) remains scant. The objective of this study was to investigate the nationwide epidemiology of positive blood cultures drawn in ICUs during the first two pandemic waves of COVID-19 in Switzerland. Methods We analyzed data on positive blood cultures among ICU patients, prospectively collected through a nationwide surveillance system (ANRESIS), from March 30, 2020, to May 31, 2021, a 14-month timeframe that included a first wave of COVID-19, which affected the French and Italian-speaking regions, an interim period (summer 2020) and a second wave that affected the entire country. We used the number of ICU patient-days provided by the Swiss Federal Office of Public Health as denominator to calculate incidence rates of blood culture contaminations and bloodstream infections (ICU-BSI). Incidence rate ratios comparing the interim period with the second wave were determined by segmented Poisson regression models. Results A total of 1099 blood culture contaminations and 1616 ICU-BSIs were identified in 52 ICUs during the study. Overall, more episodes of blood culture contaminations and ICU-BSI were observed during the pandemic waves, compared to the interim period. The proportions of blood culture contaminations and ICU-BSI were positively associated with the ICU occupancy rate, which was higher during the COVID-19 waves. During the more representative second wave (versus interim period), we observed an increased incidence of blood culture contaminations (IRR 1.57, 95% CI 1.16–2.12) and ICU-BSI (IRR 1.20, 95% CI 1.03–1.39). Conclusions An increase in blood culture contaminations and ICU-BSIs was observed during the second COVID-19 pandemic wave, especially in months when the ICU burden of COVID-19 patients was high.

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Reducing Central Venous Catheter–Associated Primary Bloodstream Infections in Intensive Care Units Is Possible: Data From The German Nosocomial Infection Surveillance System

Infection Control and Hospital Epidemiology ◽

10.1086/502236 ◽

2003 ◽

Vol 24 (7) ◽

pp. 501-505 ◽

Cited By ~ 59

Author(s):

Irina Zuschneid ◽

Frank Schwab ◽

Christine Geffers ◽

Henning Rüden ◽

Petra Gastmeier

Keyword(s):

Intensive Care ◽

Central Venous Catheter ◽

Nosocomial Infection ◽

Intensive Care Units ◽

Surveillance System ◽

Bloodstream Infections ◽

Venous Catheter ◽

Relative Reduction ◽

Central Venous ◽

Infection Surveillance

AbstractBackground And Objective:The German Nosocomial Infection Surveillance System (KISS) began in 1997 as a nationwide surveillance project for voluntary registration of nosocomial infections in intensive care units (ICUs). This study investigates trends in the rates of central venous catheter (CVC)–associated primary bloodstream infections (BSIs) in ICUs since participation in KISS.Methods:Eighty-four ICUs that had participated in KISS for at least 24 months were considered for more detailed analysis. Monthly rates of primary BSI for the 84 ICUs were pooled for the 24 months. The best model for describing the curve of reduction was sought. Additionally, incidence densities were compared using the z test.Results:For the 212 ICUs participating, a relative 25.7% decrease (from 2.1 to 1.6 primary BSIs per 1,000 CVC-days) was observed from January 1997 to June 2001. The 84 ICUs that participated in KISS for a minimum of 24 months accumulated 552,359 patient-days and 404,897 CVC-days during their 24 months. A linear regression model was selected to explain the curve of primary BSI reduction in the 84 ICUs. It showed a decrease from 2.1 to 1.5 primary BSIs per 1,000 CVC-days, meaning an overall relative reduction of 28.6% during the 2-year observation period. These results were significant (Student's t test for the monthly reduction coefficient; P = .04). The reduction of primary BSIs was shown for both clinical sepsis and laboratory-confirmed, CVC-associated primary BSIs.Conclusion:Performing surveillance with KISS was associated with a reduction of the rates of CVC-associated primary BSIs in ICU patients (Infect Control Hosp Epidemiol 2003;24:501-505).

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The national rate of intensive care units-acquired infections, one-year retrospective study in Iran

BMC Public Health ◽

10.1186/s12889-021-10639-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Neda Izadi ◽

Babak Eshrati ◽

Yadollah Mehrabi ◽

Korosh Etemad ◽

Seyed-Saeed Hashemi-Nazari

Keyword(s):

Intensive Care ◽

Tract Infection ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Increased Risk ◽

Neonatal Icu ◽

Mortality Causes ◽

One Year ◽

Multi Center Study

Abstract Background Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of “hospital-ward-month”), and then, the last observation carried forward method was used to replace the missing data. Results The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran’s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83% of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier.

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Healthcare-Associated Infection in Italy Annual Point-Prevalence Surveys, 2002–2004

Infection Control and Hospital Epidemiology ◽

10.1086/597596 ◽

2009 ◽

Vol 30 (7) ◽

pp. 659-665 ◽

Cited By ~ 21

Author(s):

Simone Lanini ◽

William R. Jarvis ◽

Emanuele Nicastri ◽

Gaetano Privitera ◽

Giovanni Gesu ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Univariate Analysis ◽

National Health System ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Point Prevalence ◽

Healthcare Associated Infection ◽

Tract Infections ◽

Healthcare Associated

Objective.Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point-prevalence surveys.Design.Three point-prevalence surveys.Methods.A total of 9,609 patients were surveyed.Results.The overall frequency of HAI was 6.7% (645 infections among the 9,609 surveyed patients). The most frequent HAIs were lower respiratory tract infections, which accounted for 35.8% (231 of 645 HAIs) of all HAIs, followed by urinary tract infections (152 [23.6%] of 645 HAIs), bloodstream infections (90 [14.0%] of 645 HAIs), and surgical site infections (79 [12.2%] of 645 HAIs). In both multivariate and univariate analysis, invasive procedures, duration of stay, chemotherapy, trauma, coma, and the location of the hospital were all factors statistically significantly associated with the occurrence of an HAL Enterobacteriaceae were the most common isolates recovered in medical and surgical wards, whereas gram-negative aerobic bacilli were the most common isolates recovered in intensive care units. Approximately one-half of all of the patients surveyed were receiving antibiotics at the time of our study; the most used antibiotic classes were fluoroquinolones in medical wards, cephalosporins in surgical wards, and penicillins and glycopeptides in intensive care units.Conclusion.Our study emphasizes the need for implementing further HAI surveillance to provide the National Health System with proper tools to prevent and manage infection in hospitalized patients.

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Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study

Medical Mycology ◽

10.1093/mmy/myy127 ◽

2018 ◽

Vol 57 (6) ◽

pp. 668-674 ◽

Cited By ~ 1

Author(s):

Ferhat Arslan ◽

Hulya Caskurlu ◽

Sema Sarı ◽

Hayriye Cankar Dal ◽

Sema Turan ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Intensive Care Units ◽

Case Control Study ◽

Absolute Risk ◽

Subsequent Development ◽

Bloodstream Infections ◽

Case Control ◽

Prior Exposure ◽

Control Study

Abstract Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56–3.14); prior exposure to N-acetylcysteine, 0.11 (0.03–0.34) and prior surgical intervention, 1.26 (0.76–2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.

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The Ability of Intensive Care Units to Maintain Zero Central Line–Associated Bloodstream Infections

Archives of Internal Medicine ◽

10.1001/archinternmed.2011.161 ◽

2011 ◽

Vol 171 (9) ◽

pp. 856 ◽

Cited By ~ 17

Author(s):

Allison Lipitz-Snyderman

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Central Line

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Reduction in Central Line–Associated Bloodstream Infections Among Patients in Intensive Care Units—Pennsylvania, April 2001–March 2005

JAMA ◽

10.1001/jama.295.3.269 ◽

2006 ◽

Vol 295 (3) ◽

pp. 269 ◽

Cited By ~ 5

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Central Line

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Analysis of Central Line–Associated Bloodstream Infections in the Intensive Care Unit after Implementation of Central Line Bundles

Infection Control and Hospital Epidemiology ◽

10.1086/652157 ◽

2010 ◽

Vol 31 (05) ◽

pp. 551-553 ◽

Cited By ~ 29

Author(s):

Emily K. Shuman ◽

Laraine L. Washer ◽

Jennifer L. Arndt ◽

Christy A. Zalewski ◽

Robert C. Hyzy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Central Line ◽

Line Bundles ◽

Blood Samples ◽

Central Lines ◽

Definition Of ◽

Contaminated Blood

Central line-associated bloodstream infections (CLABSIs) have been reduced in number but not eliminated in our intensive care units with use of central line bundles. We performed an analysis of remaining CLABSIs. Many bloodstream infections that met the definition of CLABSI had sources other than central lines or represented contaminated blood samples.

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