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Original Research: Critical Care |

A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center

Anna M. Civitarese, BS; Eric Ruggieri, PhD; J. Matthias Walz, MD; Deborah Ann Mack, RN, CIC; Stephen O. Heard, MD; Michael Mitchell, MD; Craig M. Lilly, MD; Karen E. Landry, BS; Richard T. Ellison, III, MD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDepartment of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA

bDepartment of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA

cDepartment of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical School, Worcester, MA

dInfection Control Department, UMass Memorial Medical Center, Worcester, MA

eDepartment of Pathology, University of Massachusetts Medical School, Worcester, MA

fDepartment of Medicine, University of Massachusetts Medical School, Worcester, MA

gGraduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA

hDepartment of Critical Care Operations, UMass Memorial Health Care, Worcester, MA

iDepartment of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA

CORRESPONDENCE TO: Anna M. Civitarese, BS, Infection Control Department, University of Massachusetts Memorial Medical Center, 55 Lake Ave North, Worcester, MA 01655


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1011-1017. doi:10.1016/j.chest.2017.02.008
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Background  The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center.

Methods  This was a retrospective analysis of all positive-result blood cultures among patients admitted to seven adult ICUs for fiscal year 2005 (FY2005) through FY2014 according to Centers for Disease Control and Prevention National Healthcare Safety Network definitions. The rate of change for primary and secondary hospital-onset BSIs was determined, as was the distribution of organisms responsible for these BSIs. Data from three medical, two general surgical, one combined neurosurgical/trauma, and one cardiac/cardiac surgery adult ICU were analyzed.

Results  Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1,000 patient days in FY2005 to 0.32/1,000 patient days in FY2014; an 85.0% decrease (P < .0001). Secondary BSIs also progressively decreased from 3.56/1,000 to 0.66/1,000 patient days; an 81.4% decrease (P < .0001). The decrease in BSI rates remained significant after controlling for the number of blood cultures obtained and patient acuity.

Conclusions  An increased focus on reducing hospital-onset infections at the academic medical center since 2005, including multimodal multidisciplinary efforts to prevent central line-associated BSIs, pneumonia, Clostridium difficile disease, surgical site infections, and urinary tract infections, was associated with progressive and sustained decreases for both primary and secondary hospital-onset BSIs.

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