In the Journals

Pathogen-specific strategies may augment current efforts used for prevention of CLABSIs

A greater understanding of the pathogens associated with central line-associated bloodstream infections may increase the efficacy of current prevention strategies and decrease the national prevalence of these infections, according to a study published in Infection Control & Hospital Epidemiology.

“Central line-associated bloodstream infections (CLABSIs) are a leading cause of health care-associated infections. They are associated with increased mortality, length of stay and health care costs,” the authors wrote. “A better understanding of how CLABSI pathogen distribution has changed over time in different locations and the current predominant pathogens could inform prevention efforts.”

Shannon A. Novosad , MD, MPH, of the Division of Healthcare Quality Promotion at the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, and colleagues evaluated CLABSI data from the CDC’s National Healthcare Safety Network (NHSN) that was collected between 2011 and 2017. The acute-care locations included in the analysis were divided into five mutually exclusive patient care locations, including adult ICUs, pediatric ICUs, adult wards, pediatric wards and oncology wards. Pathogens were separated into six categories based on literature that demonstrated that they were a leading cause of CLABSIs or hypothesized to be a mode of CLABSI transmission; these pathogens included Enterobacteriaceae; gram-negative bacteria that originate primarily from environmental reservoirs (including Pseudomonas aeruginosa and Serratia marcescens), Enterococcus species, Staphylococcus aureus, coagulase-negative staphylococci and Candida species/yeast.

When a CLABSI with more than one pathogen was identified, Novosad and colleagues counted each pathogen as a separate CLABSI event. The researchers calculated the distribution of the different pathogen categories by year in each type of acute-care location and reported those as percentages.

Between 2011 and 2017, 136,264 CLABSIs were reported to the NHSN. These infections occurred most frequently in adult ICUs and wards, accounting for 44% and 30%, respectively, of all CLABSIs in the time period examined by Novosad and colleagues.

Distribution of pathogens varied from facility to facility. Enterobacteriaceae was the most frequently reported pathogen group in all locations except adult ICUs; the most commonly reported pathogen group in these units was Candida species/yeast. Incidence density rates also changed throughout the course of the study. Most pathogens in adult locations decreased, although Candida species/yeast in adult ICUs and Enterobacteriaceae in oncology wards increased. In pediatric ICUs, only coagulase-negative staphylococci and Candida species/yeast decreased. In other pediatric facilities, pathogen groups remained the same.

One notable finding of this study is the role of Enterobacteriaceae as a cause of bloodstream infections, which represented the largest pathogen group in all locations except for adult ICUs, according to Novosad and colleagues.

“This . . . is particularly concerning in light of the emergence and spread of highly resistant Enterobacteriaceae, including extended-spectrum beta-lactamase-producing and carbapenemase-producing strains,” the authors wrote.

Novosad and colleagues suggest that prevention efforts that focus on specific pathogens may be one way to enhance current strategies and contribute to a greater decrease in national CLABSI rates.

“Great strides have been made in reducing CLABSIs over the last decade, but further reductions in these serious infections are needed, including work to ensure implementation of proven interventions around [central venous catheter] insertion and maintenance,” the authors wrote. “In locations that are adhering routinely to these interventions but are still having higher than expected CLABSIs, additional novel solutions for CLABSI prevention may be needed. Better understanding the pathogen distribution can help identify emerging trends and issues that might inform more targeted, pathogen-specific prevention strategies, leading to further reductions in these highly morbid infections.” – by Erin T. Welsh

Disclosures: The authors report no relevant financial disclosures.

A greater understanding of the pathogens associated with central line-associated bloodstream infections may increase the efficacy of current prevention strategies and decrease the national prevalence of these infections, according to a study published in Infection Control & Hospital Epidemiology.

“Central line-associated bloodstream infections (CLABSIs) are a leading cause of health care-associated infections. They are associated with increased mortality, length of stay and health care costs,” the authors wrote. “A better understanding of how CLABSI pathogen distribution has changed over time in different locations and the current predominant pathogens could inform prevention efforts.”

Shannon A. Novosad , MD, MPH, of the Division of Healthcare Quality Promotion at the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, and colleagues evaluated CLABSI data from the CDC’s National Healthcare Safety Network (NHSN) that was collected between 2011 and 2017. The acute-care locations included in the analysis were divided into five mutually exclusive patient care locations, including adult ICUs, pediatric ICUs, adult wards, pediatric wards and oncology wards. Pathogens were separated into six categories based on literature that demonstrated that they were a leading cause of CLABSIs or hypothesized to be a mode of CLABSI transmission; these pathogens included Enterobacteriaceae; gram-negative bacteria that originate primarily from environmental reservoirs (including Pseudomonas aeruginosa and Serratia marcescens), Enterococcus species, Staphylococcus aureus, coagulase-negative staphylococci and Candida species/yeast.

When a CLABSI with more than one pathogen was identified, Novosad and colleagues counted each pathogen as a separate CLABSI event. The researchers calculated the distribution of the different pathogen categories by year in each type of acute-care location and reported those as percentages.

Between 2011 and 2017, 136,264 CLABSIs were reported to the NHSN. These infections occurred most frequently in adult ICUs and wards, accounting for 44% and 30%, respectively, of all CLABSIs in the time period examined by Novosad and colleagues.

Distribution of pathogens varied from facility to facility. Enterobacteriaceae was the most frequently reported pathogen group in all locations except adult ICUs; the most commonly reported pathogen group in these units was Candida species/yeast. Incidence density rates also changed throughout the course of the study. Most pathogens in adult locations decreased, although Candida species/yeast in adult ICUs and Enterobacteriaceae in oncology wards increased. In pediatric ICUs, only coagulase-negative staphylococci and Candida species/yeast decreased. In other pediatric facilities, pathogen groups remained the same.

One notable finding of this study is the role of Enterobacteriaceae as a cause of bloodstream infections, which represented the largest pathogen group in all locations except for adult ICUs, according to Novosad and colleagues.

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“This . . . is particularly concerning in light of the emergence and spread of highly resistant Enterobacteriaceae, including extended-spectrum beta-lactamase-producing and carbapenemase-producing strains,” the authors wrote.

Novosad and colleagues suggest that prevention efforts that focus on specific pathogens may be one way to enhance current strategies and contribute to a greater decrease in national CLABSI rates.

“Great strides have been made in reducing CLABSIs over the last decade, but further reductions in these serious infections are needed, including work to ensure implementation of proven interventions around [central venous catheter] insertion and maintenance,” the authors wrote. “In locations that are adhering routinely to these interventions but are still having higher than expected CLABSIs, additional novel solutions for CLABSI prevention may be needed. Better understanding the pathogen distribution can help identify emerging trends and issues that might inform more targeted, pathogen-specific prevention strategies, leading to further reductions in these highly morbid infections.” – by Erin T. Welsh

Disclosures: The authors report no relevant financial disclosures.