A ten-year review of healthcare-associated bloodstream infections from forty hospitals in Québec, Canada

Healthcare-associated bloodstream infection trends under a provincial surveillance program

OBJECTIVE

BACTOT, Quebec's healthcare-associated bloodstream infection (HABSI) surveillance program has been operating since 2007. In this study, we evaluated the changes in HABSI rates across 10 years of BACTOT surveillance under a Bayesian framework.

DESIGN

A retrospective, cohort study of eligible hospitals having participated in BACTOT for at least 3 years, regardless of their entry date. Multilevel Poisson regressions were fitted independently for cases of HABSI, catheter-associated bloodstream infections (CA-BSIs), non-catheter-associated primary BSIs (NCA-BSIs), and BSIs secondary to urinary tract infections (BSI-UTIs) as the outcome and log of patient days as the offset. The log of the mean Poisson rate was decomposed as the sum of a surveillance year effect, period effect, and hospital effect. The main estimate of interest was the cohort-level rate in years 2-10 of surveillance relative to year 1.

RESULTS

Overall, 17,479 cases and 33,029,870 patient days were recorded for the cohort of 77 hospitals. The pooled 10-year HABSI rate was 5.20 per 10,000 patient days (95% CI, 5.12-5.28). For HABSI, CA-BSI, and BSI-UTI, there was no difference between the estimated posterior rates of years 2-10 compared to year 1. The posterior means of the NCA-BSI rate ratios increased from the seventh year until the tenth year, when the rate was 29% (95% confidence interval, 1%-89%) higher than the first year rate.

CONCLUSIONS

HABSI rates and those of the most frequent subtypes remained stable over the surveillance period. To achieve reductions in incidence, we recommend that more effort be expended in active interventions against HABSI alongside surveillance.

Inpatient healthcare-associated bloodstream infections in older people

This retrospective study describes inpatient healthcare-associated bloodstream infections (HABSI) in older adults and explores whether urinary catheters (presence/insertion/removal) were related to HABSI events. One hundred and sixty-seven HABSI events were identified, predominantly (124, 74%) with Gram-negative bacteria. HABSI was attributed to a urinary source in 110 patients (66%), with over half (63, 57%) of these associated with urinary catheters. Catheter-associated HABSI may be avoidable and potential preventative strategies are discussed.

Isolation matters-processing blood for Raman microspectroscopic identification of bacteria

Bacteremia with its high mortality is a frequent case in clinical health care. Further, bacteremia includes the considerable risk of progressing to a sepsis. Even in case of survival, sepsis still entails diminished quality of life for the survivors and high indirect cost for the society. The crucial factor in sepsis is time. Therefore, timely description of adequate antibiotics is vital to reduce mortality and improve quality of life after survival. Despite that, the current gold standard of clinical bacteria diagnostic is based on cultivation of bacteria, which requires an average of 13-h cultivation. Consequently, there is a necessity for culture free identification methods without sacrificing the range of bacteria strains which can be identified. Raman microspectroscopy in general requires only single bacteria cells and has proven to offer high identification accuracies. However, the prerequisite for Raman microspectroscopy is a suitable isolation strategy to obtain single unharmed bacteria cells free from matrix. Moreover, in blood, bacteria are outnumbered by billions of blood cells. In this study, we present an isolation strategy to recover single bacteria cells from blood and evaluate their suitability for Raman microspectroscopic identification. Graphical abstract.