Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens
Open Access
- 10 June 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 66 (9), 2119-2125
- https://doi.org/10.1093/jac/dkr231
Abstract
Gram-positive microorganisms have been the predominant pathogens in central venous catheter-related bloodstream infections (CRBSIs). Recent guidelines recommend empirical therapy according to this and restrict coverage for Gram-negatives to specific circumstances. This study aimed to analyse the epidemiological changes in CRBSIs over the 1991–2008 period and to analyse predictors of Gram-negative CRBSIs. A prospectively collected cohort of patients with confirmed CRBSIs was analysed. Strains isolated and antimicrobial susceptibility, as well as clinical and demographic variables were recorded. Differences observed during the study period were analysed by means of a χ2 trend test and factors associated with Gram-negative CRBSIs by means of multivariable analysis. Between 1991 and 2008, 1129 episodes of monomicrobial CRBSIs were recorded. There was an increase in the incidence of CRBSIs, from 0.10 (1991–92) to 0.31 (2007–08) episodes/1000 patient-days. A significant increase in the number of Gram-negative strains among the total isolates was also found, from 3 (4.7%) in 1991–92 to 70 (40.23%) in 2007–08, with a parallel decrease in the percentage of Gram-positives. Solid organ transplantation, prior use of penicillins and hospital stay longer than 11 days were independently associated with a significantly higher risk of Gram-negative CRBSIs, while cirrhosis, diabetes and use of quinolones were associated with a higher risk of Gram-positives. Gram-negative strains are an increasing cause of CRBSIs, reaching a prevalence of 40% in the 2007–08 period in our hospital. If this trend is confirmed in other centres, a broad-spectrum empirical therapy should be considered in managing these infections.This publication has 20 references indexed in Scilit:
- Between Community and Hospital: Healthcare-Associated Gram-Negative Bacteremia among Hospitalized PatientsInfection Control & Hospital Epidemiology, 2009
- Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpectedJournal of Hospital Infection, 2009
- Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2009
- Epidemiology of bacteremia episodes in a single center: increase in Gram-negative isolates, antibiotics resistance, and patient ageEuropean Journal of Clinical Microbiology & Infectious Diseases, 2008
- Predictive Factors for the Development of Central Line–Associated Bloodstream Infection Due to Gram-Negative Bacteria in Intensive Care Unit Patients After SurgeryInfection Control & Hospital Epidemiology, 2008
- Intravascular catheter-related infections: advances in diagnosis, prevention, and managementThe Lancet Infectious Diseases, 2007
- Reemergence of Gram-negative Health Care–Associated Bloodstream InfectionsArchives of Internal Medicine, 2006
- The International Sepsis Forum Consensus Conference on Definitions of Infection in the Intensive Care UnitCritical Care Medicine, 2005
- Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in SepsisSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1992
- Morbidity and Mortality Associated with Multiple Episodes of Nosocomial Bloodstream Infection: A Cohort StudyInfection Control & Hospital Epidemiology, 1989