title: A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center.
abstract: The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center.
  
  
  
  This was a retrospective analysis of all positive-result blood cultures among patients admitted to seven adult ICUs for fiscal year 2005 (FY2005) through FY2014 according to Centers for Disease Control and Prevention National Healthcare Safety Network definitions. The rate of change for primary and secondary hospital-onset BSIs was determined, as was the distribution of organisms responsible for these BSIs. Data from three medical, two general surgical, one combined neurosurgical/trauma, and one cardiac/cardiac surgery adult ICU were analyzed.
  
  
  
  Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1,000 patient days in FY2005 to 0.32/1,000 patient days in FY2014; an 85.0% decrease (P < .0001). Secondary BSIs also progressively decreased from 3.56/1,000 to 0.66/1,000 patient days; an 81.4% decrease (P < .0001). The decrease in BSI rates remained significant after controlling for the number of blood cultures obtained and patient acuity.
  
  
  
  An increased focus on reducing hospital-onset infections at the academic medical center since 2005, including multimodal multidisciplinary efforts to prevent central line-associated BSIs, pneumonia, Clostridium difficile disease, surgical site infections, and urinary tract infections, was associated with progressive and sustained decreases for both primary and secondary hospital-onset BSIs.
authors.affiliation: Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA. Electronic address: civitarese.anna@gmail.com.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Civitarese
authors.affiliation: Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA.
authors.forename: Eric
authors.initials: E
authors.lastname: Ruggieri
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: J Matthias
authors.initials: JM
authors.lastname: Walz
authors.affiliation: Infection Control Department, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Deborah Ann
authors.initials: DA
authors.lastname: Mack
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Heard
authors.affiliation: Department of Pathology, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA; Department of Critical Care Operations, UMass Memorial Health Care, Worcester, MA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
authors.affiliation: Department of Critical Care Operations, UMass Memorial Health Care, Worcester, MA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Landry
authors.affiliation: Infection Control Department, UMass Memorial Medical Center, Worcester, MA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA; Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Ellison
mesh_terms: D018806:APACHE; D000046:Academic Medical Centers; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D000071997:Blood Culture; D058387:Candidemia / Q000453:epidemiology* / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000150:complications; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D016015:Logistic Models; D009026:Mortality; D011552:Pseudomonas Infections / Q000150:complications / Q000453:epidemiology*; D012141:Respiratory Tract Infections / Q000150:complications; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000150:complications; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000150:complications; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications
keywords: ICU; bacteremia; bloodstream infection; central line-associated bloodstream infection; hospital-onset bacteremia; nosocomial