title: Central line-associated bloodstream infections among critically-ill patients in the era of bundle care.
abstract: OBJECTIVE
  Patients admitted to intensive care units (ICUs) are at high risk for central line-associated bloodstream infections (CLABSIs). Bundle care has been documented to reduce CLABSI rates in Western countries, however, few reports were from Asian countries and the differences in the epidemiology or outcomes of critically-ill patients with CLABSIs after implementation of bundle care remain unknown. We aimed to evaluate the incidence, microbiological characteristics, and factors associated with mortality in critically-ill patients after implementation of bundle care.
  
  
  METHODS
  Prospective surveillance was performed on patients admitted to ICUs at the National Taiwan University Hospital, Taipei, Taiwan from January 2012 to June 2013. The demographic, microbiological, and clinical data of patients who developed CLABSI according to the National Healthcare Safety Network definition were reviewed. A total of 181 episodes of CLABSI were assessed in 156 patients over 46,020 central-catheter days.
  
  
  RESULTS
  The incidence of CLABSI was 3.93 per 1000 central-catheter days. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (39.2%), followed by Gram-positive bacteria (33.2%) and Candida spp. (27.6%). Median time from insertion of a central catheter to occurrence of CLABSI was 8 days. In multivariate analysis, the independent factors associated with mortality were higher Pitt bacteremia score [odds ratio (OR) 1.41; 95% confidence interval (CI) 1.18-1.68] and longer interval between onset of CLABSIs and catheter removal (OR 1.10; 95% CI 1.02-1.20), respectively.
  
  
  CONCLUSIONS
  In institutions with a high proportion of CLABSI caused by Gram-negative bacteria, severity of bacteremia and delay in catheter removal were significant factors associated with mortality.
authors: Center for Drug Evaluation, Taipei, Taiwan.
authors: Kuan-Yin
authors: KY
authors: Lin
authors: Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
authors: Aristine
authors: A
authors: Cheng
authors: Infection Control Center, National Taiwan University Hospital, Taipei, Taiwan.
authors: Yu-Ching
authors: YC
authors: Chang
authors: Infection Control Center, National Taiwan University Hospital, Taipei, Taiwan.
authors: Mei-Chuan
authors: MC
authors: Hung
authors: Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Jann-Tay
authors: JT
authors: Wang
authors: Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: whsheng@ntu.edu.tw.
authors: Wang-Huei
authors: WH
authors: Sheng
authors: Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Po-Ren
authors: PR
authors: Hseuh
authors: Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Yee-Chun
authors: YC
authors: Chen
authors: Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Shan-Chwen
authors: SC
authors: Chang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000628:therapy; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D016638:Critical Illness; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000628:therapy; D005658:Fungi / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles / Q000379:methods*; D011446:Prospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Bloodstream infection; Central line; Intensive care unit; Mortality; Risk factor