scholarly journals 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 ◽  
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.

scholarly journals Bacteraemia in Intensive Care Unit: Clinical, Bacteriological, and Prognostic Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Zineb Lachhab ◽  
Mohammed Frikh ◽  
Adil Maleb ◽  
Jalal Kasouati ◽  
Nouafal Doghmi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Common Source ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamases ◽  
Gram Negative Organisms ◽  
One Year

Objectives.We conducted a one-year observational study from December 2012 to November 2013 to describe the epidemiology of bacteraemia in intensive care units (ICU) of Mohammed V Military Teaching Hospital of Rabat (Morocco).Methods.The study consisted of monitoring all blood cultures coming from intensive care units and studying the bacteriological profile of positive blood cultures as well as their clinical significance.Results.During this period, a total of 46 episodes of bacteraemia occurred, which corresponds to a rate of 15,4/1000 patients. The rate of nosocomial infections was 97% versus 3% for community infections. The most common source of bacteraemia was the lungs in 33%, but no source was identified in 52% of the episodes. Gram negative organisms were isolated in 83,6% of the cases withAcinetobacter baumanniibeing the most frequent. Antibiotic resistance was very high with 42,5% of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and 100% of carbapenemase inAcinetobacter baumannii. The antibiotherapy introduced in the first 24 hours was adequate in 72% of the cases.Conclusions.Bloodstream infections in ICU occur most often in patients over 55 years, with hypertension and diabetes. The bacteria involved are mainly Gram negative bacteria multiresistant to antibiotics. Early administration of antibiotics significantly reduces patients mortality.

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

2014 ◽  
Vol 53 (2) ◽  
pp. 648-652 ◽  
Author(s):  
André Karch ◽  
Stefanie Castell ◽  
Frank Schwab ◽  
Christine Geffers ◽  
Hannah Bongartz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Intensive Care Units ◽  
Poisson Regression ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Target Range ◽  
Locally Weighted Regression ◽  
Infection Surveillance ◽  
Reference Threshold

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.

Central-Line–Associated Bloodstream Infections in Québec Intensive Care Units: Results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN)

2016 ◽  
Vol 37 (10) ◽  
pp. 1186-1194 ◽  
Author(s):  
Lynne Li ◽  
Elise Fortin ◽  
Claude Tremblay ◽  
Muleka Ngenda-Muadi ◽  
Caroline Quach ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Incidence Rates ◽  
Surveillance Program ◽  
Central Venous ◽  
Healthcare Associated

BACKGROUNDFollowing implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks.METHODSCLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007–2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs).RESULTSIn total, 1,355 lab-confirmed CLABSIs over 911,205 central venous catheter days (CVC days) were recorded. The overall pooled incidence rate (IR) was 1.49 cases per 1,000 CVC days. IRs for adult teaching ICUs, nonteaching ICUs, neonatal ICUs (NICUs), and pediatric ICUs (PICUs) were 1.04, 0.91, 4.20, and 2.15 cases per 1,000 CVC days, respectively. Using fixed SPIN 2007–2009 benchmarks, CLABSI rates had decreased significantly in all ICUs except for PICUs by 2014. Rates declined by 55% in adult teaching ICUs, 52% in adult nonteaching ICUs, and 38% in NICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower and adult nonteaching ICUs had lower or comparable rates, whereas NICU and PICU rates were higher.CONCLUSIONQuébec ICU CLABSI surveillance shows declining CLABSI rates in adult ICUs. The absence of a decrease in CLABSI rate in NICUs and PICUs highlights the need for continued surveillance and analysis of factors contributing to higher rates in these populations.Infect Control Hosp Epidemiol 2016;1–9

scholarly journals Clinicians' Knowledge, Attitudes, and Practices regarding Infections with Multidrug-Resistant Gram-Negative Bacilli in Intensive Care Units

2013 ◽  
Vol 34 (3) ◽  
pp. 274-283 ◽  
Author(s):  
Juyan Julia Zhou ◽  
Sameer J. Patel ◽  
Haomiao Jia ◽  
Scott A. Weisenberg ◽  
E. Yoko Furuya ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Patient Outcomes ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Attitudes And Practices ◽  
Icu Physicians ◽  
The Impact

Objective.To assess how healthcare professionals caring for patients in intensive care units (ICUs) understand and use antimicrobial susceptibility testing (AST) for multidrug-resistant gram-negative bacilli (MDR-GNB).Design.A knowledge, attitude, and practice survey assessed ICU clinicians' knowledge of antimicrobial resistance, confidence interpreting AST results, and beliefs regarding the impact of AST on patient outcomes.Setting.Sixteen ICUs affiliated with NewYork-Presbyterian Hospital.Participants.Attending physicians and subspecialty residents with primary clinical responsibilities in adult or pediatric ICUs as well as infectious diseases subspecialists and clinical pharmacists.Methods.Participants completed an anonymous electronic survey. Responses included 4-level Likert scales dichotomized for analysis. Multivariate analyses were performed using generalized estimating equation logistic regression to account for correlation of respondents from the same ICU.Results.The response rate was 51% (178 of 349 eligible participants); of the respondents, 120 (67%) were ICU physicians. Those caring for adult patients were more knowledgeable about antimicrobial activity and were more familiar with MDR-GNB infections. Only 33% and 12% of ICU physicians were familiar with standardized and specialized AST methods, respectively, but more than 95% believed that AST improved patient outcomes. After adjustment for demographic and healthcare provider characteristics, those familiar with treatment of MDR-GNB bloodstream infections, those aware of resistance mechanisms, and those aware of AST methods were more confident that they could interpret AST results and/or request additional in vitro testing.Conclusions.Our study uncovered knowledge gaps and educational needs that could serve as the foundation for future interventions. Familiarity with MDR-GNB increased overall knowledge, and familiarity with AST increased confidence interpreting the results.

Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units

2013 ◽  
Vol 34 (11) ◽  
pp. 1167-1173 ◽  
Author(s):  
Ana C. Blanchard ◽  
Elise Fortin ◽  
Isabelle Rocher ◽  
Dorothy L. Moore ◽  
Charles Frenette ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Case Fatality ◽  
Bloodstream Infections ◽  
Central Line ◽  
Incidence Rates ◽  
Neonatal Intensive Care Units ◽  
Surveillance Program ◽  
Utilization Ratio

Objective.Describe the epidemiology of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) participating in a standardized and mandatory CLABSI surveillance program.Design.Retrospective cohort.Setting.We included patients admitted (April 2007-March 2011) to 7 level II/III NICUs who developed a CLABSI (as defined by the National Healthcare Safety Network).Methods. CLABSIs/1,000 central line–days and device utilization ratio were calculated; x2 test, Student t test, Kruskal-Wallis, and Poisson regression were used.Results.Overall, 191 patients had 202 CLABSI episodes for a pooled mean rate of 4.0 CLABSIs/1,000 central line-days and a device utilization ratio of 0.20. Annual pooled mean CLABSI rates increased from 3.6 in 2007-2008 to 5.1 CLABSIs/1,000 central line-days in 2010-2011 (P = .01). The all-cause 30-day case fatality proportion was 8.9% (n = 17) and occurred a median of 8 days after CLABSI. Coagulase-negative Staphylococcus was identified in 112 (50.5%) cases. Staphylococcus aureus was identified in 22 cases, and 3 (13.6%) were resistant to methicillin. An underlying intra-abdominal pathology was found in 20% (40/202) of CLABSI cases, 50% of which were reported in the last year of study. When adjusted for mean birth weight, annual CLABSI incidence rates were independently associated with the proportion of intra-abdominal pathology (P = .007) and the proportion of pulmonary pathology (P = .016) reported.Conclusion.The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation.

scholarly journals Time to Grow Positive Blood Cultures and Its Impact on Clinical Outcomes in Patients with Bacteremia Admitted to Intensive Care Unit

2021 ◽  
pp. 1-6
Author(s):  
Rashid Nadeem ◽  
Ashraf M. Elhoufi ◽  
Lamiaa Salama ◽  
Mayada Mahmoud ◽  
Islam Bon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Clinical Outcomes ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Comorbid Conditions ◽  
Mortality And Morbidity ◽  
Causes Of Mortality ◽  
The Impact

Introduction: Bloodstream infections are one of the leading causes of mortality and morbidity. Time to positive blood culture may be reflective of the severity of infection. We aim to study the impact of time to positivity (TTP) of blood culture upon clinical outcome. Methods: Data from blood cultures for 17 months duration reviewed. Outcome measures included in-hospital mortality and length of stay in ICU (LOSICU). TTP was determined for each sample. Demographics (age, gender, BMI, and nationality), APACHE-2 score for severity of illness, comorbid conditions, and other confounding factors were recorded. Results: One hundred and one patients with 346 positive blood cultures with mean age of 62 and mean APACHE-2 score of 18.9 + 9.7 (mean +SD) with overall observed mortality of 61%. Median TTP was 20.2 h with quartiles cutoff Q1 = 15.3, Q2 = 20.2, Q3 = 28, and range 8–104 h. Only APACHE-2 scores predict LOSICU. TTP is not a significant predictor for mortality or LOSICU. Discussion: Data on TTP of blood cultures have a complex interaction with clinical outcomes. Conclusion: TTP of blood cultures does not predict mortality or length of stay in ICU.

scholarly journals Impact of the Revised Non–Culture-Based Methodology Criteria on Central-Line–Associated Bloodstream Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s266-s266
Author(s):  
Geehan Suleyman ◽  
Thomas Chevalier ◽  
Nisreen Murad ◽  
George Alangaden
Keyword(s):  
Blood Culture ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Molecular Test ◽  
Current Definition ◽  
Previous Definition ◽  
The Impact ◽  
Positive Results ◽  
Clabsi Rate

Background: The current NHSN guideline states that positive results from both blood cultures and non–culture-based testing (NCT) methodologies are to be used for central-line–associated bloodstream infection (CLABSI) surveillance determination. A positive NCT result in the absence of blood cultures or negative blood cultures in patients who meet CLABSI criteria is to be reported to NHSN. However, the reporting criteria for NCT changed starting January 1, 2020: If NCT is positive and the blood culture is negative 2 days before or 1 day after, the NCT result is not reported. If the NCT is positive with no blood culture within the 3-day window period, the NCT result is reported in patients who meet CLABSI criteria. We estimated the impact of the new NCT criteria on CLABSI numbers and rates compared to the previous definition. Methods: At our facility, the T2Candida Panel (T2), an NCT, was implemented for clinical use for the detection of early candidemia and invasive candidiasis. The T2 is a rapid molecular test performed directly on blood samples to detect DNA of 5 Candida spp: C. albicans/C. tropicalis, C. glabrata/C. krusei, and C. parapsilosis. In this retrospective study performed at an 877-bed teaching hospital in Detroit, we reviewed the impact of discordant T2 results (positive T2 with negative blood cultures) on CLABSI rates from January 1, 2017, to September 30, 2019, based on the current definition, and we applied the revised criteria to estimate the new CLABSI numbers and rates for the same period. Results: Of 343 positive T2 results, 202 (58.9%) were discordant and qualified for CLABSI determination during the study period. Of these, 109 (54%) met CLABSI criteria based on the current definition and 11 (5%) met CLABSI criteria using the new definition (proportional P < .001), resulting in an 89.9% reduction. The CLABSI rate per 1,000 central-line days, which includes discordant T2 results, based on the current and new NCT criteria, are listed in Table 1. Conclusions: In institutions that utilize NCT such as T2, application of the new 2020 NCT NHSN definition would significantly reduce the CLABSI number and have a significant impact on the CLABSI rates and standardized infection ratios (SIRs).Funding: NoneDisclosures: None

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