Catheter-related bloodstream infections in hematology: time for standardized surveillance?
Central venous catheters are essential in the management of many malignant disorders, but catheter-related bloodstream infections (CR-BSIs) are significant complications in terms of morbidity, mortality, and healthcare expenditure. These outcome measures are useful for monitoring of infection control practice and the effect of preventive strategies. Unlike intensive care unit (ICU) populations, surveillance for CR-BSIs in the hematology population is not standardized, despite the potential value of detecting changes in rate, etiology, and changes in risk for infective complications in association with increasingly intensive chemotherapeutic regimens in this immunocompromised population. Essential components of a successful surveillance strategy include selection of a health outcome of significance, definition of goals of the surveillance system, involvement of key stakeholders in planning and development, application of valid case definitions, allocation of resources and trained personnel, risk stratification, and use of appropriate statistical methods for analysis. These are discussed with reference to patients with hematologic malignancy, together with review of previous surveillance strategies in this population. Only when these issues are addressed can a surveillance strategy reliably assess trends and compare data, leading to improved patient outcomes and a reduction in healthcare expenditure for patients with hematologic malignancy.
Worth
Leon J
LJ
Centre for Clinical Research Excellence in Infectious Disease, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia. leon.worth@petermac.org
Slavin
Monica A
MA
Brown
Graham V
GV
Black
James
J
D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D016469:Fungemia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D017053:Infection Control; D011159:Population Surveillance; D012307:Risk Factors