title: Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens.
abstract: OBJECTIVE
  Gram-positive microorganisms have been the predominant pathogens in central venous catheter-related bloodstream infections (CRBSIs). Recent guidelines recommend empirical therapy according to this and restrict coverage for Gram-negatives to specific circumstances. This study aimed to analyse the epidemiological changes in CRBSIs over the 1991-2008 period and to analyse predictors of Gram-negative CRBSIs.
  
  
  METHODS
  A prospectively collected cohort of patients with confirmed CRBSIs was analysed. Strains isolated and antimicrobial susceptibility, as well as clinical and demographic variables were recorded. Differences observed during the study period were analysed by means of a χ² trend test and factors associated with Gram-negative CRBSIs by means of multivariable analysis.
  
  
  RESULTS
  Between 1991 and 2008, 1129 episodes of monomicrobial CRBSIs were recorded. There was an increase in the incidence of CRBSIs, from 0.10 (1991-92) to 0.31 (2007-08) episodes/1000 patient-days. A significant increase in the number of Gram-negative strains among the total isolates was also found, from 3 (4.7%) in 1991-92 to 70 (40.23%) in 2007-08, with a parallel decrease in the percentage of Gram-positives. Solid organ transplantation, prior use of penicillins and hospital stay longer than 11 days were independently associated with a significantly higher risk of Gram-negative CRBSIs, while cirrhosis, diabetes and use of quinolones were associated with a higher risk of Gram-positives.
  
  
  CONCLUSIONS
  Gram-negative strains are an increasing cause of CRBSIs, reaching a prevalence of 40% in the 2007-08 period in our hospital. If this trend is confirmed in other centres, a broad-spectrum empirical therapy should be considered in managing these infections.
authors.affiliation: Department of Infectious Diseases, Hospital Clínic of Barcelona, C/ Villarroel 170, Barcelona 08036, Spain. mmarcos@usal.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Marcos
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.forename: Amaia
authors.initials: A
authors.lastname: Iñurrieta
authors.forename: José A
authors.initials: JA
authors.lastname: Martínez
authors.forename: Alberto
authors.initials: A
authors.lastname: Romero
authors.forename: Nazaret
authors.initials: N
authors.lastname: Cobos
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernández
authors.forename: Manel
authors.initials: M
authors.lastname: Almela
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D002177:Candidiasis / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D055499:Catheter-Related Infections / Q000097:blood* / Q000453:epidemiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood* / Q000453:epidemiology* / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents