Better nosocomial bacteremia, fungemia case definition may improve treatment
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Key takeaways:
- CLABSI and non-CLABSI hospital onset bacteremia or fungemia are common.
- Both infections have high mortality rates, readmission risk, costs and longer length of stay.
Better definition of hospital onset bacteremia and fungemia patients could improve care, including reducing mortality rates, higher readmission risk and cost, and longer length of stay, a study found.
Central line-associated bloodstream infection (CLABSI) and hospital onset bacterimia and fungemia (HOB) have similar rates of mortality, readmission and hospital stay but if HOBs are focused on similar to CLABSI, researchers say care could improve.
“In light of CLABSI rates improving nationwide before the pandemic, the CDC has proposed to CMS a new metric that would be simultaneously easier to extract from electronic medical records and include bloodstream infections acquired during hospitalization from other non-central line sources,” Kalvin C. Yu, MD, FIDSA, vice president of medical affairs at Becton, Dickinson and Company, told Healio.
“Because HOB is not a mandatory CMS quality metric like CLABSI, there is a serious lack of knowledge on the clinical outcomes, consequences and cost in patients who get a HOB. We therefore wanted to define those clinical care gaps and potential opportunities for improving patient outcomes by delineating what was at stake for patients, health care systems and the clinicians who champion both,” Yu said.
Yu and colleagues performed a retrospective observational study of patients in 41 acute-care hospitals. The researchers evaluated patient characteristics, other positive cultures (urine, respiratory, or skin and soft-tissue), and microorganisms in a cross-sectional analysis cohort and explored adjusted patient outcomes, including length of stay (LOS), hospital cost and mortality in a 1:5 case-matched cohort.
According to the study, CLABSI cases were defined as those reported to the National Healthcare Safety Network (NHSN), whereas HOB was defined as a positive blood culture with an eligible bloodstream organism collected on or after day 4.
Overall, 403 patients with NHSN-reportable CLABSIs and 1,574 with non-CLABSI HOB were included in the cross-sectional analysis, with positive non-bloodstream cultures with the same microorganism as in the bloodstream being reported in 9.2% of CLABSI patients and 32% of non-CLABSI HOB patients.
Coagulase-negative staphylococci (20.6%) and Enterobacteriaceae (36.5%) were the most commonly reported microorganisms in CLABSI and non-CLABSI HOB cases, respectively, according to the study.
In case-matched analyses, CLABSIs and non-CLABSI HOB, either separately or combined, were associated with significantly longer LOS (12.1 to 17.4 days depending on ICU status), higher costs by between $25,207 to $55,001 per admission, and a more than 3.5-fold increased risk of mortality in patients with an ICU encounter.
“HOB events have just as serious clinical outcomes and cost ramifications as CLABSI patients,” Yu said.
“If we operate under the assumption that even a partial percentage of HOB events are preventable, we should endeavor to define those types of patients and improve care — even if incrementally at first — as we've done with CLABSI. Perfection should not get in the way of better when peoples' lives and longevity are at stake,” he concluded.
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Yu KC, et al. Infect Control Hosp Epidemiol. 2023;doi:10.1017/ice.2023.132.
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