Multi-center prospective study on central line-associated bloodstream infections in 79 ICUs of China

Abstract

Background

China has not yet established a national surveillance network such as NHSN from America, so there is still no large-scale investigations on central line-associated bloodstream infection (CLABSI) incidence. Several retrospective studies in China reported that the incidence of CLABSI varied due to inconsistent diagnostic criteria. We performed a nationwide survey to investigate the utilization rate of central venous catheters (CVCs) and the incidence of CLABSI in ICUs of different areas of China.

Methods

This is a prospective multi-center study. Patients admitted to ICUs with the use of CVCs between January 1, 2014 and December 31, 2018 were enrolled in this study. Hospitals were given the definition of catheter-related bloodstream infection as: a laboratory-confirmed bloodstream infection where CVC was in place on the date of event or the day before. The characteristics of patients, information of catheterization, implementation rates of precautions, and CLABSIs were collected. The statistical analysis was performed by SPSS 25.0 software and website of Open Source Epidemiologic Statistics for Public Health.

Results

A total of 38,212 patients and 466,585 catheter days were involved in surveillance. The average CLABSI incidence in a thousand catheter days was 1.50, the lowest incidence unit was in pediatric ICU (0/1000 catheter days), and the lowest incidence area was in Northeast China (0.77/1000 catheter days), while the highest incidence unit was in cardiac ICU (2.48/1000 catheter days) and the highest incidence area was in Eastern China (1.62/1000 catheter days). The average utilization rate of CVC was 42.85%, the lowest utilization rate was in pediatric ICU (5.85%) and in Central China (38.05%), while the highest utilization rate was in surgical ICU (64.92%) and in Western China (51.57%). Among the 702 CLABSI cases reported, a total of 735 strains of pathogens were cultured. Staphylococcus spp. was the most common organism isolated (27.07%), followed by Enterobacteriaceae (22.31%). The implementation rates of all precautions showed an upward trend during the study period ( P ≤ 0.001).

Conclusion

The average incidence of CLABSI in ICUs in China is 1.5/1000 catheter days, similar to the rates reported in developed countries but lower than previous reports in China. CLABSI incidence showed regional differences in China. It is necessary to implement targeted surveillance of CLABSI cases by using standardized CLABSI surveillance definitions and methodologies.

Contributors

Anhua Wu:

ORCID: http://orcid.org/0000-0003-2147-4582

[e-mail]

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 4 December 2021

Publication date PMC-release: 4 December 2021

Publication date Collection: 2021

Volume: 21

Affiliations

[1 ]GRID grid.452223.0, ISNI 0000 0004 1757 7615, Teaching and Research Section of Clinical Nursing, , Xiangya Hospital, Central South University, ; Changsha, China

[2 ]GRID grid.452223.0, ISNI 0000 0004 1757 7615, Department of Infection Control, , Xiangya Hospital, Central South University, ; Changsha, China

[3 ]GRID grid.411472.5, ISNI 0000 0004 1764 1621, Department of Infection Control, , Peking University First Hospital, ; Beijing, China

Article

Publisher ID: 6871

DOI: 10.1186/s12879-021-06871-5

PMC ID: 8642979

SO-VID: 969eea1c-a90a-4094-b144-5249556f37ad

Copyright statement: © The Author(s) 2021

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Funding

Funded by: Chinese Hospital Association

Award ID: CHA-2012-XSPX-0629-1

Award Recipient : Anhua Wu

Categories

Subject: Research Article

Custom metadata

issue-copyright-statement © The Author(s) 2021