Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990-2010

Abstract

Objective: To quantify historical trends in rates of central line-associated bloodstream infections (CLABSIs) in US intensive care units (ICUs) caused by major pathogen groups, including Candida spp., Enterococcus spp., specified gram-negative rods, and Staphylococcus aureus.

Design: Active surveillance in a cohort of participating ICUs through the Centers for Disease Control and Prevention, the National Nosocomial Infections Surveillance system during 1990-2004, and the National Healthcare Safety Network during 2006-2010. Setting. ICUs. Participants. Patients who were admitted to participating ICUs.

Results: The CLABSI incidence density rate for S. aureus decreased annually starting in 2002 and remained lower than for other pathogen groups. Since 2006, the annual decrease for S. aureus CLABSIs in nonpediatric ICU types was -18.3% (95% confidence interval [CI], -20.8% to -15.8%), whereas the incidence density rate for S. aureus among pediatric ICUs did not change. The annual decrease for all ICUs combined since 2006 was -17.8% (95% CI, -19.4% to -16.1%) for Enterococcus spp., -16.4% (95% CI, -18.2% to -14.7%) for gram-negative rods, and -13.5% (95% CI, -15.4% to -11.5%) for Candida spp.

Conclusions: Patterns of ICU CLABSI incidence density rates among major pathogen groups have changed considerably during recent decades. CLABSI incidence declined steeply since 2006, except for CLABSI due to S. aureus in pediatric ICUs. There is a need to better understand CLABSIs that still do occur, on the basis of microbiological and patient characteristics. New prevention approaches may be needed in addition to central line insertion and maintenance practices.

Figure 1

Pathogen-Specific Pooled Mean CLABSI Incidence Density Rate per 1,000 Central-Line Days among 7 ICU Types,* NNIS (1990–2004) and NHSN (2006–2010) CLABSI Surveillance Data *Cardiothoracic, Coronary, Medical, Medical-Surgical without Major Medical School Affiliation, Medical-Surgical with Major Medical School Affiliation, Pediatric, and Surgical ICUs

Figure 2

Parts a–d Pathogen-Specific Pooled Mean CLABSI Incidence Density Rate per 1,000 Central-Line Days among 7 ICU Types,* NNIS (1990–2004) and NHSN (2006–2010) CLABSI Surveillance Data: Figure 2a, Staphylococcus aureus; Figure 2b, Candida spp.; Figure 2c, Gram negative rods (Acinetobacter baumanii, Enterobacter species, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumonia, or Pseudomonas aeruginosa); and Figure 2d, Enterococcus spp. *Cardiothoracic, Coronary, Medical, Medical-Surgical without Major Teaching Affiliation, Medical-Surgical with Major Teaching Affiliation, Pediatric, and Surgical ICUs

Figure 2

Parts a–d Pathogen-Specific Pooled Mean CLABSI Incidence Density Rate per 1,000 Central-Line Days among 7 ICU Types,* NNIS (1990–2004) and NHSN (2006–2010) CLABSI Surveillance Data: Figure 2a, Staphylococcus aureus; Figure 2b, Candida spp.; Figure 2c, Gram negative rods (Acinetobacter baumanii, Enterobacter species, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumonia, or Pseudomonas aeruginosa); and Figure 2d, Enterococcus spp. *Cardiothoracic, Coronary, Medical, Medical-Surgical without Major Teaching Affiliation, Medical-Surgical with Major Teaching Affiliation, Pediatric, and Surgical ICUs

Figure 2

Parts a–d Pathogen-Specific Pooled Mean CLABSI Incidence Density Rate per 1,000 Central-Line Days among 7 ICU Types,* NNIS (1990–2004) and NHSN (2006–2010) CLABSI Surveillance Data: Figure 2a, Staphylococcus aureus; Figure 2b, Candida spp.; Figure 2c, Gram negative rods (Acinetobacter baumanii, Enterobacter species, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumonia, or Pseudomonas aeruginosa); and Figure 2d, Enterococcus spp. *Cardiothoracic, Coronary, Medical, Medical-Surgical without Major Teaching Affiliation, Medical-Surgical with Major Teaching Affiliation, Pediatric, and Surgical ICUs