title: Unexpected hospital-acquired bacteraemia in patients at low risk of bloodstream infection: the role of a heparin drip.
abstract: Following a cluster of cases of unexpected hospital-acquired bacteraemia suspected to be related to an intravenous (iv) heparin drip, all cases of hospital-acquired primary bloodstream infection (BSI) in patients at low risk of bacteraemia were analysed over a four-year period. Ninety-six bacteraemic patients (6%) from 1618 episodes of hospital-acquired bacteraemia had a peripheral iv line as the only risk factor. These patients were divided into two groups: 60 patients with phlebitis and 36 without local signs of inflammation. Baseline features of the two groups were comparable, but in univariate and multivariate analysis, a significant association was found between iv heparin use, predominance of Gram-negative organisms (especially Klebsiella, Serratia and Enterobacter species), and absence of phlebitis. In spite of clear statistical association, however, the means by which the heparin solution became contaminated with Gram-negative organisms remained unknown. Following implementation of infection control methods concerning heparin handling, no more cases occurred. Unexpected hospital-acquired Gram-negative bacteraemia in patients with peripheral iv lines should prompt investigation of potential infusate-related infection, especially in patients without phlebitis and those receiving iv heparin.
authors.affiliation: Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel. zihum@tasmc.health.gov.il
authors.forename: Y
authors.initials: Y
authors.lastname: Siegman-Igra
authors.forename: E
authors.initials: E
authors.lastname: Jacobi
authors.forename: R
authors.initials: R
authors.lastname: Lang
authors.forename: D
authors.initials: D
authors.lastname: Schwartz
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016470:Bacteremia / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D002406:Catheterization, Peripheral; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D048909:Diabetes Complications / Q000150:complications; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D004340:Drug Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods; D007262:Infusions, Intravenous; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D010689:Phlebitis / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D006493:Heparin