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Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy Evidence for a Proposed Modification to the Current Surveillance Definition

Published online by Cambridge University Press:  02 January 2015

James P. Steinberg ,
Chad Robichaux ,
Sheri Chernetsky Tejedor ,
Mary Dent Reyes  and
Jesse T. Jacob
James P. Steinberg*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Chad Robichaux
Affiliation:
Emory Healthcare, Atlanta, Georgia
Sheri Chernetsky Tejedor
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Mary Dent Reyes
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Jesse T. Jacob
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
*
Medical Office Tower, 5th Floor, 550 Peachtree Street NE, Atlanta, GA 30308 ([email protected])
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Abstract

Objective.

Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line-associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.

Design.

Retrospective review.

Setting.

Two large university hospitals over 18 months.

Methods.

All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3 or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.

Results.

Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group included Escherichia coli (22.7% vs 2.5%; P < .001) but not other Enterobacteriaceae, Enterococcus faecium (18.2% vs 6.1%; P = .002), and streptococci (18.2% vs 0%; P < .001). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, or E. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.

Conclusions.

Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 171 - 175
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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References

1. Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S22–S30.Google Scholar
2. O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39:S1–S34.Google Scholar
3. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
4. Tancrede, CH, Andremont, AO. Bacterial translocation and gramnegative bacteremia in patients with hematological malignancies. J Infect Dis 1985;152:99–103.Google Scholar
5. Fraser, TG, Gordon, SM. CLABSI rates in immunocompromised patients: a valuable patient centered outcome? Clin Infect Dis 2011;52:1446–1450.Google Scholar
6. DiGiorgio, M, Fatica, C, Oden, MA, et al. Defining preventable catheter associated bloodstream infections in hematologyoncology patients: use of a modified definition and its impact on rates and pathogens. Presented at: 21st annual meeting of the Society for Healthcare Epidemiology of America; Dallas, Texas; 2011. Abstract 222.Google Scholar
7. Cello, JP, Thoeni, RF. CT imaging of colitis. Radiology 2006;240: 623–638.Google Scholar
8. Hidron, AI, Edwards, JR, Patel, J, et al; for the National Healthcare Safety Network Team and Participating National Healthcare Safety Network Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996–1011.Google Scholar
9. Montgomerie, JZ, Doak, PB, Taylor, DE, North, JD, Martin, WJ. Klebsiella in faecal flora of renal-transplant patients. Lancet 1970; 2:787–792.Google Scholar
10. Cairo, J, Hachem, R, Rangaraj, G, et al. Predictors of catheterrelated gram-negative bacilli bacteraemia among cancer patients. Clin Microbiol Infect 2011;17:1711–1716.Google Scholar
11. Wiest, R, Rath, HC. Bacterial translocation in the gut. Best Pract Res Clin Gastroenterol 2003;17:397–425.Google Scholar
12. Steffen, EK, Berg, RD, Deitch, EA. Comparison of translocation rates of various indigenous bacteria from the gastrointestinal tract to the mesenteric lymph node. J Infect Dis 1988;157: 1032–1038.Google Scholar
13. Penn, RL, Maca, RD, Berg, RD. Increased translocation of bacteria from the gastrointestinal tracts of tumor-bearing mice. Infect Immun 1985;47:793–798.Google Scholar
14. Berg, RD. Bacterial translocation from the gastrointestinal tract of mice receiving immunosuppresive chemotherapeutic agents. Curr Microbiol 1983;8:285–292.Google Scholar
15. Horan, TC, Emori, TG. Definitions of key terms used in the NNIS system. Am J Infect Control 1997;25:112–116.Google Scholar
16. Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, 2009. MMRW Morb Mortal Wkly Rep 2011;60:243–248.Google Scholar