Catheter-associated primary bloodstream infections: epidemiology and preventive methods

The incidence of catheter-associated primary bloodstream infections (BSIs) in Germany as defined by the CDC (Centers for Disease Control) has been determined on the basis of (a) a national prevalence study in a representative sample of 72 hospitals (NIDEP), and (b) an incidence study in which data about the use and duration of insertion of central venous catheters (CVC) and of catheter-associated BSI were collected from 25 intensive-care units (ICUs) participating in the hospital infection surveillance system (KISS+) and analyzed. The first study showed primary bloodstream infection to be the fourth most frequent nosocomial infection at 8.3% of all nosocomial infections. With an ICU prevalence of 2.1%, primary BSI comprises 12.8% of all nosocomial infections observed in ICU patients. The second study showed a 60.4% prevalence of CVC use in German ICUs. An analysis of 55,400 CVC days in 14,988 ICU patients in the KISS hospitals yielded 2.2 CVC-associated BSIs per 1,000 CVC days (CI95 1.8-2.6). The rates of CVC-associated BSI on individual hospital wards were very variable and indicates a reduction potential. A reduction in the number of infections of about one-third would prevent 1,000-1,400 deaths due to CVC-associated BSI annually as well as about 40,000 to 60,000 extra days of hospital stay and the associated costs.