Cargando…
To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population
BACKGROUND: ECMO recipients who develop bloodstream infections (BSI) meeting CLABSI criteria are publically-reported in inter-facility comparisons and contribute to potential penalties from CMS. We aimed to determine the incidence of BSI, specifically CLABSI, following receipt of ECMO at one of the...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630759/ http://dx.doi.org/10.1093/ofid/ofx163.1693 |
_version_ | 1783269286010159104 |
---|---|
author | Seidelman, Jessica Lewis, Sarah S Huslage, Kirk Strittholt, Nancy Vereen, Sheila Sova, Christopher Taylor, Bonnie Bonadonna, Desiree Ranney, David Nag, Utlara Daneshmand, Mani Anderson, Deverick Sexton, Daniel Smith, Becky |
author_facet | Seidelman, Jessica Lewis, Sarah S Huslage, Kirk Strittholt, Nancy Vereen, Sheila Sova, Christopher Taylor, Bonnie Bonadonna, Desiree Ranney, David Nag, Utlara Daneshmand, Mani Anderson, Deverick Sexton, Daniel Smith, Becky |
author_sort | Seidelman, Jessica |
collection | PubMed |
description | BACKGROUND: ECMO recipients who develop bloodstream infections (BSI) meeting CLABSI criteria are publically-reported in inter-facility comparisons and contribute to potential penalties from CMS. We aimed to determine the incidence of BSI, specifically CLABSI, following receipt of ECMO at one of the largest ECMO centers in the US. METHODS: Adults who received ECMO at Duke University Hospital from 1/1/2014–12/31/2016 were included in the study. Cases were patients who acquired BSI during the ECMO exposure period, defined as 2 days after cannulation through 7 days after decannulation. Electronic medical records of case patients were reviewed and data were abstracted using a standardized template. To calculate CLABSI incidence rates (IR), we assumed that all patients on ECMO had 1 or more central venous catheters (CVC) for the duration of ECMO. RESULTS: 426 patients received 3532 days of ECMO during the 3-year study period. 29 (6.8%) patients acquired BSI (IR 8.2 /1000 ECMO days (ED)) after a median ECMO duration of 7 (range 2, 39) days. Of these, 13 met criteria for primary CLABSI (IR 3.7/1000 ED), whereas 9 had a single blood culture (BC) positive for a common commensal organism and 7 had BSI secondary to pneumonia. Although ECMO patients only represented 8% of CVC days during the study period, they accounted for 22% of reported CLABSIs for the medical (MICU) and cardiothoracic surgical ICUs (CTICU). 10 (77%) CLABSI patients had femoral sites of ECMO cannulation and/or CVC insertion and 12 (92%) were receiving broad-spectrum antibiotics at the time of CLABSI. Patients with CLABSI and secondary BSI predominantly had infections due to gram-negative rods (Fig 1). The organism recovered from the BC was susceptible to the antibiotics received in 14 (48%) of patients with positive BC. CONCLUSION: The rate of CLABSI was more than 3 times higher in our cohort of ECMO recipients than nationally reported rates for academic MICUs and CTICUs. Research is needed to understand the preventability of these infections, as traditional prevention measures such as avoidance of the femoral site and prophylactic ABX may not be applicable or effective in this high-risk population. Furthermore, NHSN should update its CLABSI definition and/or risk adjustment to account for hospitals with high ECMO utilization. DISCLOSURES: M. Daneshmand, Maquet: Grant Investigator, Grant recipient; D. Sexton, Centers for Disease Control and Prevention: Grant Investigator, Grant recipient; Centers for Disease Control and Prevention Foundation: Grant Investigator, Grant recipient; UpToDate: Collaborator, Royalty Recipient |
format | Online Article Text |
id | pubmed-5630759 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-56307592017-11-07 To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population Seidelman, Jessica Lewis, Sarah S Huslage, Kirk Strittholt, Nancy Vereen, Sheila Sova, Christopher Taylor, Bonnie Bonadonna, Desiree Ranney, David Nag, Utlara Daneshmand, Mani Anderson, Deverick Sexton, Daniel Smith, Becky Open Forum Infect Dis Abstracts BACKGROUND: ECMO recipients who develop bloodstream infections (BSI) meeting CLABSI criteria are publically-reported in inter-facility comparisons and contribute to potential penalties from CMS. We aimed to determine the incidence of BSI, specifically CLABSI, following receipt of ECMO at one of the largest ECMO centers in the US. METHODS: Adults who received ECMO at Duke University Hospital from 1/1/2014–12/31/2016 were included in the study. Cases were patients who acquired BSI during the ECMO exposure period, defined as 2 days after cannulation through 7 days after decannulation. Electronic medical records of case patients were reviewed and data were abstracted using a standardized template. To calculate CLABSI incidence rates (IR), we assumed that all patients on ECMO had 1 or more central venous catheters (CVC) for the duration of ECMO. RESULTS: 426 patients received 3532 days of ECMO during the 3-year study period. 29 (6.8%) patients acquired BSI (IR 8.2 /1000 ECMO days (ED)) after a median ECMO duration of 7 (range 2, 39) days. Of these, 13 met criteria for primary CLABSI (IR 3.7/1000 ED), whereas 9 had a single blood culture (BC) positive for a common commensal organism and 7 had BSI secondary to pneumonia. Although ECMO patients only represented 8% of CVC days during the study period, they accounted for 22% of reported CLABSIs for the medical (MICU) and cardiothoracic surgical ICUs (CTICU). 10 (77%) CLABSI patients had femoral sites of ECMO cannulation and/or CVC insertion and 12 (92%) were receiving broad-spectrum antibiotics at the time of CLABSI. Patients with CLABSI and secondary BSI predominantly had infections due to gram-negative rods (Fig 1). The organism recovered from the BC was susceptible to the antibiotics received in 14 (48%) of patients with positive BC. CONCLUSION: The rate of CLABSI was more than 3 times higher in our cohort of ECMO recipients than nationally reported rates for academic MICUs and CTICUs. Research is needed to understand the preventability of these infections, as traditional prevention measures such as avoidance of the femoral site and prophylactic ABX may not be applicable or effective in this high-risk population. Furthermore, NHSN should update its CLABSI definition and/or risk adjustment to account for hospitals with high ECMO utilization. DISCLOSURES: M. Daneshmand, Maquet: Grant Investigator, Grant recipient; D. Sexton, Centers for Disease Control and Prevention: Grant Investigator, Grant recipient; Centers for Disease Control and Prevention Foundation: Grant Investigator, Grant recipient; UpToDate: Collaborator, Royalty Recipient Oxford University Press 2017-10-04 /pmc/articles/PMC5630759/ http://dx.doi.org/10.1093/ofid/ofx163.1693 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Seidelman, Jessica Lewis, Sarah S Huslage, Kirk Strittholt, Nancy Vereen, Sheila Sova, Christopher Taylor, Bonnie Bonadonna, Desiree Ranney, David Nag, Utlara Daneshmand, Mani Anderson, Deverick Sexton, Daniel Smith, Becky To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population |
title | To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population |
title_full | To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population |
title_fullStr | To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population |
title_full_unstemmed | To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population |
title_short | To Be a CLABSI or Not to Be a CLABSI—That Is the Question: The Epidemiology of Bloodstream Infections in a Large ECMO Population |
title_sort | to be a clabsi or not to be a clabsi—that is the question: the epidemiology of bloodstream infections in a large ecmo population |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630759/ http://dx.doi.org/10.1093/ofid/ofx163.1693 |
work_keys_str_mv | AT seidelmanjessica tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT lewissarahs tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT huslagekirk tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT strittholtnancy tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT vereensheila tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT sovachristopher tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT taylorbonnie tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT bonadonnadesiree tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT ranneydavid tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT nagutlara tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT daneshmandmani tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT andersondeverick tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT sextondaniel tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation AT smithbecky tobeaclabsiornottobeaclabsithatisthequestiontheepidemiologyofbloodstreaminfectionsinalargeecmopopulation |