title: Epidemiology of central line-associated bloodstream infections in Quebec intensive care units: a 6-year review.
abstract: BACKGROUND
  The burden of central line-associated bloodstream infections (CLABSI) in Canadian intensive care units (ICUs) is not well established. The present study aimed to describe CLABSI epidemiology in Quebec ICUs during 2003-2009.
  
  
  METHODS
  The study population was a retrospective dynamic cohort of 58 ICUs that participated in the Surveillance Provinciale des Infections Nosocomiales program during 2003-2009. We calculated annual CLABSI incidence rates (IRs), central venous catheter (CVC) utilization ratios, and case-fatality proportions, and described the pathogens involved. We analyzed data using descriptive statistics and standardized incidence ratios.
  
  
  RESULTS
  A total of 891 CLABSIs were identified during 446,137 CVC-days. In 2003-2009, CLABSI IRs were 1.67 CLABSI/1,000 CVC-days in adult ICUs, 2.20 CLABSIs/1,000 CVC-days in pediatric ICUs, and 4.40 CLABSIs/1,000 CVC-days in neonatal ICUs. Since 2007, CLABSI IRs in adult, pediatric and neonatal ICUs have decreased by 11%, 50%, and 18%, respectively. Pediatric ICUs had the highest CVC utilization ratio (median, 0.61; interquartile range, 0.57-0.66). Coagulase-negative staphylococci caused 53% of the CLABSIs. The proportion of methicillin-resistant Staphylococcus aureus declined from 70% to <40% after 2006.
  
  
  CONCLUSIONS
  CLABSIs result in a considerable burden of illness in Quebec ICUs. However, CLABSI IRs have decreased since 2007, and the proportion of methicillin-resistant S aureus has remained <40% since 2006. Continuous surveillance is essential to determine whether these changes are sustainable.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Fontela
authors.forename: Robert W
authors.initials: RW
authors.lastname: Platt
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rocher
authors.forename: Charles
authors.initials: C
authors.lastname: Frenette
authors.forename: Dorothy
authors.initials: D
authors.lastname: Moore
authors.forename: Elise
authors.initials: E
authors.lastname: Fortin
authors.forename: David
authors.initials: D
authors.lastname: Buckeridge
authors.forename: Madukhar
authors.initials: M
authors.lastname: Pai
authors.forename: Caroline
authors.initials: C
authors.lastname: Quach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality