Loading…
Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy: Evidence for a Proposed Modification to the Current Surveillance Definition
Objective. Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line–associated BSIs (CL...
Saved in:
Published in: | Infection control and hospital epidemiology 2013-02, Vol.34 (2), p.171-175 |
---|---|
Main Authors: | , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c337t-faca95bf5e0810c0fa18f4e423d687a83bb7b968e7e27a757ac23459925be62a3 |
---|---|
cites | cdi_FETCH-LOGICAL-c337t-faca95bf5e0810c0fa18f4e423d687a83bb7b968e7e27a757ac23459925be62a3 |
container_end_page | 175 |
container_issue | 2 |
container_start_page | 171 |
container_title | Infection control and hospital epidemiology |
container_volume | 34 |
creator | Steinberg, James P. Robichaux, Chad Tejedor, Sheri Chernetsky Reyes, Mary Dent Jacob, Jesse T. |
description | Objective. Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line–associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.
Design. Retrospective review.
Setting. Two large university hospitals over 18 months.
Methods. All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3 or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.
Results. Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group included Escherichia coli (22.7% vs 2.5%;
) but not other Enterobacteriaceae, Enterococcus faecium (18.2% vs 6.1%;
), and streptococci (18.2% vs 0%;
). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, or E. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.
Conclusions. Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition. |
doi_str_mv | 10.1086/669082 |
format | article |
fullrecord | <record><control><sourceid>jstor_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1273314380</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>10.1086/669082</jstor_id><sourcerecordid>10.1086/669082</sourcerecordid><originalsourceid>FETCH-LOGICAL-c337t-faca95bf5e0810c0fa18f4e423d687a83bb7b968e7e27a757ac23459925be62a3</originalsourceid><addsrcrecordid>eNp10c1u1DAQB_AIgehS4BGQJQTismDHSWz3VrYFKi1QCZC4RRNn3HWV2IvttOqNd-D5uPAkON0FTpzsw-8_H5qieMzoS0Zl86ppFJXlnWLB6lotG8mru8WCSqWWsuRfD4oHMV5SSoVS7H5xUPJS1XXDF8XPExtTsN2UrHfEG3IOaeMv0EViHVmhSwEGsrYOf33_cRyj1xYS9uT14H2fkwgjOXMG9ZyPBEbvLuYaNicjubZpQ8D1tx8_JfIBpxT8Fp0FYvww-Gub_WqDo08bDLC9OSKnV7ZHpzGDQICcZ-9jbvne99ZYDbeTJk9ygKymEHIn8mkKV2iHAebcCRrr7MweFvcMDBEf7d_D4sub08-rd8v1x7dnq-P1UnMu0tKABlV3pkYqGdXUAJOmwqrkfSMFSN51olONRIGlAFEL0CWvaqXKusOmBH5YvNjV3Qb_bcKY2tFGjfM86KfYslJwziouaabPd1QHH2NA026DHSHctIy28ynb3SkzfLKvOXUj9n_Zn9tl8GwPIGoYTMjL2_jPCVYxoWR2T3fuMiYf_tfuNyH4t9I</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1273314380</pqid></control><display><type>article</type><title>Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy: Evidence for a Proposed Modification to the Current Surveillance Definition</title><source>Cambridge Journals Online</source><creator>Steinberg, James P. ; Robichaux, Chad ; Tejedor, Sheri Chernetsky ; Reyes, Mary Dent ; Jacob, Jesse T.</creator><creatorcontrib>Steinberg, James P. ; Robichaux, Chad ; Tejedor, Sheri Chernetsky ; Reyes, Mary Dent ; Jacob, Jesse T.</creatorcontrib><description>Objective. Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line–associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.
Design. Retrospective review.
Setting. Two large university hospitals over 18 months.
Methods. All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3 or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.
Results. Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group included Escherichia coli (22.7% vs 2.5%;
) but not other Enterobacteriaceae, Enterococcus faecium (18.2% vs 6.1%;
), and streptococci (18.2% vs 0%;
). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, or E. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.
Conclusions. Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1086/669082</identifier><identifier>PMID: 23295563</identifier><language>eng</language><publisher>Chicago, IL: University of Chicago Press</publisher><subject>Bacteremia ; Bacteremia - microbiology ; Bacterial diseases ; Bacterial sepsis ; Bacterial Translocation ; Biological and medical sciences ; Blood ; Catheter-Related Infections - classification ; Catheter-Related Infections - microbiology ; Chemotherapy ; Cross Infection - classification ; Cross Infection - epidemiology ; Enterobacteriaceae ; Gastrointestinal tract ; Hematologic and hematopoietic diseases ; Hospitals, University ; Human bacterial diseases ; Humans ; Infections ; Infectious diseases ; Medical sciences ; Microbiology ; Miscellaneous ; Neutropenia ; Neutropenia - diagnosis ; Neutropenia - etiology ; Nursing ; Oncology ; Original Article ; Other diseases. Hematologic involvement in other diseases ; Pathogens ; Population Surveillance ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Retrospective Studies</subject><ispartof>Infection control and hospital epidemiology, 2013-02, Vol.34 (2), p.171-175</ispartof><rights>2012 by The Society for Healthcare Epidemiology of America. All rights reserved.</rights><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-faca95bf5e0810c0fa18f4e423d687a83bb7b968e7e27a757ac23459925be62a3</citedby><cites>FETCH-LOGICAL-c337t-faca95bf5e0810c0fa18f4e423d687a83bb7b968e7e27a757ac23459925be62a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27141798$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23295563$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Steinberg, James P.</creatorcontrib><creatorcontrib>Robichaux, Chad</creatorcontrib><creatorcontrib>Tejedor, Sheri Chernetsky</creatorcontrib><creatorcontrib>Reyes, Mary Dent</creatorcontrib><creatorcontrib>Jacob, Jesse T.</creatorcontrib><title>Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy: Evidence for a Proposed Modification to the Current Surveillance Definition</title><title>Infection control and hospital epidemiology</title><addtitle>Infect Control Hosp Epidemiol</addtitle><description>Objective. Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line–associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.
Design. Retrospective review.
Setting. Two large university hospitals over 18 months.
Methods. All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3 or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.
Results. Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group included Escherichia coli (22.7% vs 2.5%;
) but not other Enterobacteriaceae, Enterococcus faecium (18.2% vs 6.1%;
), and streptococci (18.2% vs 0%;
). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, or E. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.
Conclusions. Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.</description><subject>Bacteremia</subject><subject>Bacteremia - microbiology</subject><subject>Bacterial diseases</subject><subject>Bacterial sepsis</subject><subject>Bacterial Translocation</subject><subject>Biological and medical sciences</subject><subject>Blood</subject><subject>Catheter-Related Infections - classification</subject><subject>Catheter-Related Infections - microbiology</subject><subject>Chemotherapy</subject><subject>Cross Infection - classification</subject><subject>Cross Infection - epidemiology</subject><subject>Enterobacteriaceae</subject><subject>Gastrointestinal tract</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hospitals, University</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Microbiology</subject><subject>Miscellaneous</subject><subject>Neutropenia</subject><subject>Neutropenia - diagnosis</subject><subject>Neutropenia - etiology</subject><subject>Nursing</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Other diseases. Hematologic involvement in other diseases</subject><subject>Pathogens</subject><subject>Population Surveillance</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Retrospective Studies</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp10c1u1DAQB_AIgehS4BGQJQTismDHSWz3VrYFKi1QCZC4RRNn3HWV2IvttOqNd-D5uPAkON0FTpzsw-8_H5qieMzoS0Zl86ppFJXlnWLB6lotG8mru8WCSqWWsuRfD4oHMV5SSoVS7H5xUPJS1XXDF8XPExtTsN2UrHfEG3IOaeMv0EViHVmhSwEGsrYOf33_cRyj1xYS9uT14H2fkwgjOXMG9ZyPBEbvLuYaNicjubZpQ8D1tx8_JfIBpxT8Fp0FYvww-Gub_WqDo08bDLC9OSKnV7ZHpzGDQICcZ-9jbvne99ZYDbeTJk9ygKymEHIn8mkKV2iHAebcCRrr7MweFvcMDBEf7d_D4sub08-rd8v1x7dnq-P1UnMu0tKABlV3pkYqGdXUAJOmwqrkfSMFSN51olONRIGlAFEL0CWvaqXKusOmBH5YvNjV3Qb_bcKY2tFGjfM86KfYslJwziouaabPd1QHH2NA026DHSHctIy28ynb3SkzfLKvOXUj9n_Zn9tl8GwPIGoYTMjL2_jPCVYxoWR2T3fuMiYf_tfuNyH4t9I</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Steinberg, James P.</creator><creator>Robichaux, Chad</creator><creator>Tejedor, Sheri Chernetsky</creator><creator>Reyes, Mary Dent</creator><creator>Jacob, Jesse T.</creator><general>University of Chicago Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130201</creationdate><title>Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy: Evidence for a Proposed Modification to the Current Surveillance Definition</title><author>Steinberg, James P. ; Robichaux, Chad ; Tejedor, Sheri Chernetsky ; Reyes, Mary Dent ; Jacob, Jesse T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-faca95bf5e0810c0fa18f4e423d687a83bb7b968e7e27a757ac23459925be62a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Bacteremia</topic><topic>Bacteremia - microbiology</topic><topic>Bacterial diseases</topic><topic>Bacterial sepsis</topic><topic>Bacterial Translocation</topic><topic>Biological and medical sciences</topic><topic>Blood</topic><topic>Catheter-Related Infections - classification</topic><topic>Catheter-Related Infections - microbiology</topic><topic>Chemotherapy</topic><topic>Cross Infection - classification</topic><topic>Cross Infection - epidemiology</topic><topic>Enterobacteriaceae</topic><topic>Gastrointestinal tract</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hospitals, University</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Medical sciences</topic><topic>Microbiology</topic><topic>Miscellaneous</topic><topic>Neutropenia</topic><topic>Neutropenia - diagnosis</topic><topic>Neutropenia - etiology</topic><topic>Nursing</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Other diseases. Hematologic involvement in other diseases</topic><topic>Pathogens</topic><topic>Population Surveillance</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Steinberg, James P.</creatorcontrib><creatorcontrib>Robichaux, Chad</creatorcontrib><creatorcontrib>Tejedor, Sheri Chernetsky</creatorcontrib><creatorcontrib>Reyes, Mary Dent</creatorcontrib><creatorcontrib>Jacob, Jesse T.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Steinberg, James P.</au><au>Robichaux, Chad</au><au>Tejedor, Sheri Chernetsky</au><au>Reyes, Mary Dent</au><au>Jacob, Jesse T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy: Evidence for a Proposed Modification to the Current Surveillance Definition</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect Control Hosp Epidemiol</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>34</volume><issue>2</issue><spage>171</spage><epage>175</epage><pages>171-175</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>Objective. Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line–associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.
Design. Retrospective review.
Setting. Two large university hospitals over 18 months.
Methods. All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3 or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.
Results. Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group included Escherichia coli (22.7% vs 2.5%;
) but not other Enterobacteriaceae, Enterococcus faecium (18.2% vs 6.1%;
), and streptococci (18.2% vs 0%;
). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, or E. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.
Conclusions. Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.</abstract><cop>Chicago, IL</cop><pub>University of Chicago Press</pub><pmid>23295563</pmid><doi>10.1086/669082</doi><tpages>5</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0899-823X |
ispartof | Infection control and hospital epidemiology, 2013-02, Vol.34 (2), p.171-175 |
issn | 0899-823X 1559-6834 |
language | eng |
recordid | cdi_proquest_miscellaneous_1273314380 |
source | Cambridge Journals Online |
subjects | Bacteremia Bacteremia - microbiology Bacterial diseases Bacterial sepsis Bacterial Translocation Biological and medical sciences Blood Catheter-Related Infections - classification Catheter-Related Infections - microbiology Chemotherapy Cross Infection - classification Cross Infection - epidemiology Enterobacteriaceae Gastrointestinal tract Hematologic and hematopoietic diseases Hospitals, University Human bacterial diseases Humans Infections Infectious diseases Medical sciences Microbiology Miscellaneous Neutropenia Neutropenia - diagnosis Neutropenia - etiology Nursing Oncology Original Article Other diseases. Hematologic involvement in other diseases Pathogens Population Surveillance Public health. Hygiene Public health. Hygiene-occupational medicine Retrospective Studies |
title | Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy: Evidence for a Proposed Modification to the Current Surveillance Definition |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-23T15%3A19%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-jstor_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Distribution%20of%20Pathogens%20in%20Central%20Line%E2%80%93Associated%20Bloodstream%20Infections%20among%20Patients%20with%20and%20without%20Neutropenia%20following%20Chemotherapy:%20Evidence%20for%20a%20Proposed%20Modification%20to%20the%20Current%20Surveillance%20Definition&rft.jtitle=Infection%20control%20and%20hospital%20epidemiology&rft.au=Steinberg,%20James%20P.&rft.date=2013-02-01&rft.volume=34&rft.issue=2&rft.spage=171&rft.epage=175&rft.pages=171-175&rft.issn=0899-823X&rft.eissn=1559-6834&rft_id=info:doi/10.1086/669082&rft_dat=%3Cjstor_proqu%3E10.1086/669082%3C/jstor_proqu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c337t-faca95bf5e0810c0fa18f4e423d687a83bb7b968e7e27a757ac23459925be62a3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1273314380&rft_id=info:pmid/23295563&rft_jstor_id=10.1086/669082&rfr_iscdi=true |