title: Central line-associated bloodstream infections in Australian intensive care units: Time-trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009-2013.
abstract: BACKGROUND
  The epidemiology of central line-associated bloodstream infections (CLABSI) in Australian intensive care units (ICUs) has not previously been reported. We sought to describe time-trends in CLABSI rates, infections by ICU peer-groups, etiology, and antimicrobial susceptibility of pathogens in a large cohort of Australian ICUs for the period January 1, 2009-December 31, 2013.
  
  
  METHODS
  Using National Healthcare Safety Network methods, CLABSI surveillance in adult patients was performed by hospitals participating in the Victorian Healthcare Associated Infection Surveillance System (n = 29). Hospitals were grouped by location, sector, and teaching status.
  
  
  RESULTS
  Overall, 384 CLABSI events were reported over 303,968 central venous catheter (CVC)-days, corresponding to a rate of 1.26/1,000 CVC-days (95% confidence interval, 1.14-1.40). Every 1-year increase was associated with a 26% reduction in CLABSI risk (risk ratio, 0.74, 95% confidence interval, 0.69-0.80; P < .001). The most frequently identified pathogens were Enterococcus spp (26.3%), followed by Candida spp (15.4%) and Staphylococcus aureus (13.3%). CLABSI due to Enterococcus spp, S aureus, and coagulase-negative Staphylococcus spp displayed significant reductions over time.
  
  
  CONCLUSIONS
  Internationally accepted surveillance methods have been employed in Australia, demonstrating CLABSI rates comparable to medical/surgical ICUs in the United States and a reduction in pathogen-specific infections over a 5-year period.
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia. Electronic address: leon.worth@mh.org.au.
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Bull
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Brett
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Richards
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged
keywords: Antimicrobial susceptibility; Bloodstream infection; Central venous catheter; Device-associated infection; Epidemiology