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Original Research |

A ten-year review of total hospital onset intensive care unit 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

Conflicts of Interest: None.

1Department of Biology & Biotechnology, Worcester Polytechnic Institute, Worcester, MA

2Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA

3Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical School, Worcester, MA

4Infection Control Department, UMass Memorial Medical Center, Worcester, MA

5Department of Pathology, University of Massachusetts Medical School, Worcester, MA

6Department of Medicine, University of Massachusetts Medical School, Worcester, MA

7Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA

8Department of Critical Care Operations, UMass Memorial Health Care, Worcester, MA

9Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA

Address for reprints: Richard T. Ellison III, Division of Infectious Diseases, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

∗∗Corresponding author: Anna M. Civitarese Box # G-S 121-3 Brown University School of Public Health 121 S. Main Street, Providence, RI 02903.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.02.008
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Abstract

Objective  The rates of central line–associated bloodstream infections (CLABSIs) in United States intensive care units (ICU) 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.

Design  This was a retrospective analysis of all positive blood cultures among patients admitted to seven adult ICUs for the period 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.

Setting  Three medical, two general surgical, one combined neurosurgical /trauma, and one cardiac/cardiac surgery adult intensive care units.

Results  Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1000 patient days in FY05 to 0.32/1000 patient days in FY14; an 85.0% decrease (P<0.0001). Secondary BSIs also progressively decreased from 3.56/1000 to 0.66/1000 patient days; an 81.4% decrease (P<0.0001). The decrease of 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 during the last 10 years, 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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