Scientists from the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention analysed central-line–associated bloodstream infection (CLABSI) data from the CDC National Healthcare Safety Network (NHSN) to better understand the distribution of CLABSI pathogens in acute-care hospitals.¹ The study aimed to inform infection prevention and control specialists in improving CLABSIs prevention efforts.

Adult intensive care units (ICUs) and wards reported the highest number of CLABSIs of 44% and 30%, respectively; the most common pathogens were Candida spp/yeast in adult ICUs and Enterobacteriaceae in adult wards, paediatric wards, oncology wards, and paediatric ICUs (PICUs).¹ The rate ratio of pathogen-specific CLABSIs decreased during the surveillance period (i.e., 2011 to 2017) with the exception of Candida spp/yeast CLABSIs in adult ICUs and Enterobacteriaceae CLABSIs in oncology wards.

CLABSIs are the leading cause of healthcare-associated infections (HAIs) and are associated with prolonged hospitalisation, increased mortality, and increased healthcare costs.¹ The implementation of evidence-based prevention measures and guidelines has resulted in a 50% reduction in the incidence rate of CLABSIs in the United States from 2008 to 2014 and a further 9% decrease from 2016 to 2017.^2-5

Considering the emergence of antimicrobial resistant Enterobacteriaceae including the extended-spectrum β-lactamases (ESBL)-producing and carbapenemase-producing strains, the observation of a 50% increase in Enterobacteriaceae CLABSIs in oncology wards has been alarming.¹ Colonisation of Gram-negative bacteria in the gastrointestinal tract has been shown to increase the risk of subsequent HAIs, including Gram negative bacteraemia.⁶ Novel prevention strategies such as selective decontamination of the digestive tract,⁷ manipulation of patient’s microbiome,⁶ and chlorhexidine gluconate bathing^8,9 can be effective in reducing Gram negative HAIs to a certain extent. However, better interventions targeted at Enterobacteriaceae are needed.

The authors of this study have also noted the increase in Candida spp/yeast CLABSIs in adult ICUs since 2011.¹ The increase is partly attributed to the change in the NHSN urinary tract infection (UTI) definition in 2015 by reclassifying secondary BSIs as primary BSIs and excluding yeast as a cause for UTIs.¹  The emergence of Candida auris, which persists in the healthcare environment has prompted efforts in improving healthcare environmental cleaning to address the role of non-albicans Candida spp in HAIs.^10,11 In addition, interventions aimed at improving water quality in healthcare institutions – as well as cleaning and disinfection of surfaces around sinks – have been implemented to minimise exposure to Staphylococcus aureus, another pathogen responsible for a sizable proportion of CLABSIs.^12,13

The authors concluded that while great progress has been made in reducing CLABSIs over the last decade, better understanding of pathogen distribution can help improve pathogen-specific prevention strategies for further reductions of serious infections.

References

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4. Centers for Disease Control and Prevention. National and state healthcare-associated infections progress report. Available at: https://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Accessed 28 April 2020.
5. Centers for Disease Control and Prevention. Current HAI progress report. Available at: https://www.cdc.gov/hai/data/portal/progress-report.html. Accessed 28 April 2020.
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