title: Surveillance of catheter-related infections: the supplementary role of the microbiology laboratory.
abstract: BACKGROUND
  The burden of catheter-related infections (CRIs) in developing countries is severe. In South Africa, a standardised surveillance definition does not exist and the collection of catheter days is challenging. The aim of the study was to provide baseline data on the prevalence of CRIs and to describe the epidemiology of CRI events within a tertiary academic hospital.
  
  
  METHODS
  Surveillance was laboratory-based and conducted for a six month period. A microbiologically confirmed CRBSI (MC-CRBSI) event was defined as the isolation of the same microorganism from the catheter and concomitant blood cultures (BCs), within 48 h of catheter removal, which were not related to an infection at another site.
  
  
  RESULTS
  A total of 508 catheters, removed from 332 patients, were processed by the laboratory, of which only 50% (253/508 removed from 143/332 patients) of the catheters were accompanied by BCs within 48 h. Sixty-five episodes of MC-CRBSI in 57 patients were detected, involving 71 catheters and 195 microbial isolates. The institutional prevalence rate was 3.7 episodes per 1 000 admissions and 5.8 episodes per 10 000 in-patient days. Catheter day data was collected in only six wards of the hospital. The pooled laboratory incidence was 10.1 MC-CRBSI episodes per 1 000 catheter days, whereas the hospital-based central line-associated bloodstream infection (CLABSI) rate was pooled at 5.7 episodes per 1 000 catheter days. The majority of patients had an underlying gastro-intestinal condition (33%; 19/56) with a non-tunnelled, triple-lumen central venous catheter, placed in the subclavian vein (38%; 27/71). The most predominant pathogen was methicillin-resistant Staphylococcus epidermidis (28%; 55/195), followed by extensively-drug resistant Acinetobacter baumannii (18%; 35/195).
  
  
  CONCLUSIONS
  Catheter-related infection prevention and control efforts require urgent attention, not only to keep patients safe from preventable harm, but to prevent the spread of multidrug resistant microorganisms.
authors.affiliation: Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa. wilkestrasheim@gmail.com.
authors.forename: Wilhelmina
authors.initials: W
authors.lastname: Strasheim
authors.affiliation: Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa. marleen.kock@up.ac.za.|National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa. marleen.kock@up.ac.za.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Kock
authors.affiliation: Department of Internal Medicine, University of Pretoria, Pretoria, South Africa. ueckermannv@live.com.
authors.forename: Veronica
authors.initials: V
authors.lastname: Ueckermann
authors.affiliation: National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa. ebbsterus@yahoo.com.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Hoosien
authors.affiliation: Centre for Tuberculosis, National Institute of Communicable Diseases, Johannesburg, South Africa. aw.dreyer@gmail.com.
authors.forename: Andries W
authors.initials: AW
authors.lastname: Dreyer
authors.affiliation: Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa. marthie.ehlers@up.ac.za.|National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa. marthie.ehlers@up.ac.za.
authors.forename: Marthie M
authors.initials: MM
authors.lastname: Ehlers
mesh_terms: D039903:Actinobacteria / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D012307:Risk Factors; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D055815:Young Adult