A clinical practical approach to the surveillance definition of central line-associated bloodstream infection in cancer patients with mucosal barrier injury.
The Centers for Disease Control and Prevention recently introduced the concept of mucosal barrier injury (MBI) in an attempt to recognize the possibility of a gastrointestinal source for certain bloodstream infections. This could underestimate the central venous catheter (CVC) as the source of central line-associated bloodstream infection (CLABSI) in cancer. The definition of catheter-related bloodstream infection (CRBSI) by the Infectious Diseases Society of America is a more specific and stringent definition that identifies the CVC as the source of infection. In our study, we compared the 2 definitions in cancer patients.



We retrospectively reviewed 149 CLABSI cases that occurred at our center between January 2013 and March 2014 who had 2 simultaneously positive blood cultures drawn from the CVC and peripheral site or concurrent paired tip and blood cultures.



Of the 149 patients with CLABSI, only 70 (47%) had definite CRBSI. CRBSI was identified more commonly in non-MBI CLABSI cases than MBI CLABSI (69% vs 18%, P < .0001).



The CRBSI definition may be more accurate in identifying the catheter as the source of bloodstream infection in patients with MBI. Because CRBSI continues to occur in patients with MBI, we caution against excluding all MBI patients from CLABSI surveillance.
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX. Electronic address: achaftar@mdanderson.org.
Anne-Marie
AM
Chaftari
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Mary
M
Jordan
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Ray
R
Hachem
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Zanaib
Z
Al Hamal
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Ying
Y
Jiang
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Ammar
A
Yousif
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Kumait
K
Garoge
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Poonam
P
Deshmukh
Department of Infectious Diseases, Infection Control and Employee Health/Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Issam
I
Raad
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D055815:Young Adult
CLABSI; CRBSI; Central line–associated bloodstream infection; MBI; catheter-related bloodstream infection; mucosal barrier injury