Epidemiology of Vascular Catheter-related Bloodstream Infections in a Large University Hospital in Israel

Abstract

Intravascular catheter-related infection and associated bacteraemia constitute a serious and increasing problem among nosocomial infections. As a part of an ongoing survey of positive blood cultures, all catheter-related bloodstream infections (CR-BSI) were reviewed in the authors' Medical Center in 1996, in order to evaluate the magnitude and seriousness of this problem. The largest group (28%) of hospital-acquired bacteraemia by 1 source of infection during 1996 was CR-BSI, identified in 110 patients with 126 episodes. The vascular line was central in 83 (66%), peripheral in 24 (19%), tunnelled in 18 (14%) and arterial in 1 (1%). Among the 83 central CR-BSI no sign of local inflammation was detected in 65%. Gram-positive and Gram-negative bacteria shared equal parts among the 145 blood isolates; Staphylococcus aureus was the most common species (43/145, 30%) followed by Klebsiella pneumoniae (15/145, 10%); 11 (8%) isolates were Candida species. Fungal isolates were more common among tunnelled catheter infections than among others (6/18, 33% vs. 5/108, 5%, p<0.001). Crude mortality was 35% (38/110), while attributable mortality was 14% (15/110), mostly associated with central line infection. Catheter-associated bacteraemias cause significant morbidity and mortality, and have become the most common source of hospital-acquired bacteraemia. There is a need to implement more effective infection-control measures and more advanced technologies in an effort to reduce this unacceptably high incidence.