Major article
Central line-associated bloodstream infections in Australian intensive care units: Time-trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009-2013

https://doi.org/10.1016/j.ajic.2015.03.036Get rights and content

Background

The epidemiology of central line-associated bloodstream infections (CLABSI) in Australian intensive care units (ICUs) has not previously been reported. We sought to describe time-trends in CLABSI rates, infections by ICU peer-groups, etiology, and antimicrobial susceptibility of pathogens in a large cohort of Australian ICUs for the period January 1, 2009-December 31, 2013.

Methods

Using National Healthcare Safety Network methods, CLABSI surveillance in adult patients was performed by hospitals participating in the Victorian Healthcare Associated Infection Surveillance System (n = 29). Hospitals were grouped by location, sector, and teaching status.

Results

Overall, 384 CLABSI events were reported over 303,968 central venous catheter (CVC)-days, corresponding to a rate of 1.26/1,000 CVC-days (95% confidence interval, 1.14-1.40). Every 1-year increase was associated with a 26% reduction in CLABSI risk (risk ratio, 0.74, 95% confidence interval, 0.69-0.80; P < .001). The most frequently identified pathogens were Enterococcus spp (26.3%), followed by Candida spp (15.4%) and Staphylococcus aureus (13.3%). CLABSI due to Enterococcus spp, S aureus, and coagulase-negative Staphylococcus spp displayed significant reductions over time.

Conclusions

Internationally accepted surveillance methods have been employed in Australia, demonstrating CLABSI rates comparable to medical/surgical ICUs in the United States and a reduction in pathogen-specific infections over a 5-year period.

Section snippets

Methods

The Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre was established for the purpose of monitoring a range of health care-associated infection outcomes and relevant processes in Victorian hospitals, including CLABSI.10 The CLABSI surveillance module is based on methods employed by the CDC/NHSN.11, 12 For our study, data collected between January 1, 2009, and December 31, 2013, were analyzed to characterize time-trends.

Results

Between January 1, 2009, and the December 31, 2013, 29 Victorian health care facilities participated in CLABSI surveillance activities. A total of 303,968 CVC-days were monitored and 384 CLABSI events were reported, corresponding to an overall rate of 1.26/1,000 CVC-days (95% confidence interval [CI], 1.14-1.40). Of patients with infection, 155 (40.4%) were women and 228 (59.4%) were men (patient sex was not recorded in 1 instance). Median age at infection was 59.9 years (interquartile range,

Discussion

This study represents the largest multicenter evaluation of CLABSI events in Australian ICUs utilizing internationally accepted criteria for CLABSI surveillance. Our findings demonstrate an overall CLABSI rate comparable to medical/surgical ICUs in the United States,15 with a reduction in pathogen-specific CLABSI rates over a 5-year period. Significant reductions were observed in CLABSI rates due to Enterococcus spp, Staphylococcus aureus, and CNS.

A reduction in DUR was observed throughout the

Conclusions

We report diminishing CLABSI events in Victorian ICUs during the period 2009-2013. Although significant reductions have been observed over time, data do not reflect zero tolerance across our region. Reasons for CLABSI reduction require further evaluation to enable key prevention strategies to be adopted widely, and particularly in settings where higher CLABSI rates have been observed (eg, public and metropolitan hospitals).

Acknowledgments

The authors thank the infection prevention consultants in participating Victorian hospitals for collecting and submitting data. The authors also thank Associate Professor Andrew Daley for reviewing this manuscript.

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    • Cited by (0)

    The Victorian Healthcare Associated Infection Surveillance System Coordinating Centre is funded by the Victorian Department of Health.

    Conflicts of interest: None to report.

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