181. Prospective Analysis of Hospital Acquired Blood Stream Infections (BSI) Managed in the Intensive Care Units (ICU) by a Multidisciplinary Team
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • poster for IDSA - CLABSIsdkk2.pdf (45.9 kB)
  • Background:

    The Centers for Medicare and Medicaid Services (CMS) require hospitals to report central line associated BSIs (CLABSIs) acquired in intensive care units (ICUs). Infection preventionists (IPs) are under increasing scrutiny to accurately report cases of CLABSI. Use of a multidisciplinary team to evaluate potential cases of CLABSI might be an effective method to identify CLABSIs.

    Methods:

    The study team prospectively reviewed all BSIs in patients from 16 ICUs across 5 hospitals of the Detroit Medical Center. Notifications of BSI were obtained through automated methods. Data were abstracted from medical records. BSI were categorized per NHSN criteria by a validation team (2 infectious diseases/hospital epidemiologists, 1 intensivist, and 1 senior IP). Team members were blinded as to location of the case being reviewed

    Results:

    Data were collected from 12/1/12-4/1/13. 96 BSIs were reviewed and 63 categorized as hospital acquired bacteremias (HAB) (occurring after 48 hours of hospitalization). The most common bacteria were S. aureus (n=14), S. epidermidis (n=6) and Enterococcus faecalis (n=7). Among patients with HAB, the mean age was 69.7, 51% were female, and 81% were African Americans. The mean APACHE 2 score was 23. Admission diagnoses included sepsis (12%), respiratory failure (10.6%) and cardiogenic shock (9%). 56% had fever, and 24% had hypothermia at the time of BSI. At least 2 SIRS criteria were noted in all but one patient.

    The most common source of BSI was CLABSI in 40% of the patients (n=25), followed by pneumonia (16%), intraabdominal infections (11%) and urinary tract infections (10%). The mean duration of stay 18 and 27 days for ICU and entire hospitalization respectively. ICU mortality was 30%. Of the 25 CLABSI identified by the validation team, 6 were reported by IPs as being CLABSI (24%). Further evaluation of the discrepant 18 case by IPs and team members is ongoing.

    Conclusion:

    CLABSI is a common source of HAB in the ICU and remains challenging to diagnosis. Utilization of a multidisciplinary team to identify CLABSI, and collaborations between this team and IPs might be useful in more effectively identifying and ultimately preventing CLABSI.

    Tal Mann, MD1, Sorabh Dhar, MD2, Sarit Sharma, MD2, Samran Haider, MD2, Gautam Balakrishnan, MD2, Harish Pulluru, MBBS2, Satya Dalta, MD2, Elaine Flanagan, BSN, MSA3 and Keith Kaye, MD, MPH, FIDSA, FSHEA3, (1)Detroit Medical Center (DMC)/ Wayne State University, Detroit, MI, (2)Detroit Medical Center (DMC) / Wayne State University, Detroit, MI, (3)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI

    Disclosures:

    T. Mann, None

    S. Dhar, None

    S. Sharma, None

    S. Haider, None

    G. Balakrishnan, None

    H. Pulluru, None

    S. Dalta, None

    E. Flanagan, None

    K. Kaye, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.