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Two-thirds of hospital-onset bacteremia, fungemia are preventable

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February 26, 2019

Two-thirds of all hospital-onset bacteremia and fungemia, or HOB, events and half of nonskin commensal HOB events are potentially preventable, according to results from a pilot study.

Writing in Infection Control & Hospital Epidemiology, Raymund B. Dantes, MD, MPH, assistant professor of medicine at the Emory University School of Medicine, and colleagues explained that rates of central-line-associated bloodstream infections (CLABSIs) — a subset of HOBs — decreased 50% between 2008 and 2014, but that those reductions have since diminished. They noted that previous studies have suggested using HOBs as a performance measure rather than CLABSIs.

“HOB could theoretically drive further improvements in patient care and could be used for public reporting,” Dante and colleagues wrote. “The overall preventability of HOB is unknown; thus, determining the degree of preventability is critical to the potential use of HOB as a quality measure.”

The researchers classified an HOB event as a microorganism growth from a blood culture obtained from hospitalized adults and critically ill children at least 3 calendar days after hospital admission. According to the study, a total of 60 randomly selected HOB events were equally included from adults at Emory University Hospital and the University of Maryland Medical Center and children at Johns Hopkins Hospital between Oct. 1, 2014, and Sept. 30, 2015.

From admission until the HOB event occurred, the researchers observed a median hospitalization duration of 13 days (interquartile range [IQR] = 7-24 days) among adult patients and 24 days (IQR = 9-60 days) among pediatric ICU patients, with 50% of adult HOB events originating from ICUs.

At a rate of 73%, Dantes and colleagues noted that central venous catheters were frequently present 2 days before and 2 days after blood cultures were obtained from patients. Less commonly present were urinary catheters (20%) and invasive mechanical ventilation (25%). Just 10% of HOB events occurred among patients without indwelling medical devices, catheters or invasive mechanical ventilation, Dante and colleagues reported.

Coagulase-negative staphylococci organisms were identified in 28% of HOB events, Candida species in 12%, methicillin-susceptible S. aureus in 10% and Enterococcus species in 10%, according to the findings.

Nonmucosal barrier injury CLABSI was the most common clinical source of HOB, found in 28% of cases, followed by skin contamination at 18% and the respiratory tract at 10%.

Overall, Dantes and colleagues judged 63% of all HOB events as potentially preventable. Of the 60 HOB events included in the study, 17 were a result of skin commensal organisms and attributed to contaminated blood cultures, they said. They found 49% of HOB events that were not a result of skin commensal organisms to be potentially preventable.

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“An important finding of this study is that only 20% of HOB events resulted in an [National Healthcare Safety Network]-reported CLABSI, suggesting that HOB events beyond CLABSIs are preventable and should be evaluated as targets for prevention,” Dantes and colleagues wrote.

“Larger studies across a variety of hospital settings are needed to assess the generalizability of these results, understand current risk factors for HOB, and develop prevention strategies,” they wrote. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

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