Peripherally inserted central catheter bloodstream infection surveillance rates in an acute care setting in Saudi Arabia

Peripherally inserted central venous catheters [PICCs] are alternatives to short-term central venous catheters and provide intravenous access in the acute hospital setting. In this study, we describe the rate of PICC-associated bloodstream infections [BSI]. Prospective cohort study using data on PICC lines reviewed from January to December 2009. The infection control team was responsible for prospective BSI case findings. The infection rate was calculated per 1000 device-days. During the study period, 92 PICC lines were inserted with a total of 3336 device-days of prospective surveillance. The most frequent reasons for the insertion of the PICC lines were chemotherapy [n=19, 20.7%], intravenous antimicrobial therapy [n=34, 37%], and for patients in the medical intensive care unit [ICU] [n=16, 17.4%]. The overall BSI rate was 4.5/1000 PICC days. The PICC line-associated BSI rates for a specific indication were as follows: chemotherapy 6.6/1000 device-days, intravenous antimicrobial therapy 1.2/1000 device-days, medical ICU 7.3/1000 device-days, surgical ICU 4.6/1000 device-days, and total parental nutrition patients 2.4/1000 device-days [P<.001]. The rates were not adjusted for patient severity of illness. Our data suggest that underlying conditions and indications for the PICC line use may play an important role in the development of BSI

Prevalence and antimicrobial resistance of health care associated bloodstream infections at a general hospital in Saudi Arabia

To determine the trend of health care associated blood stream infection [HA-BSI] at Saudi Aramco Medical Services Organization. This prospective survey was conducted during the year 2002-2006. Definitions of HA-BSI infections were based on the Centers for Disease Control and Prevention categories. There were a total of 1103 distinct episodes of HA-BSI with annual average rates of 8.5 per 1000 discharges and 18 per 10,000 patient-days. Of all episodes, 38% were primary, 47% were central line-associated bloodstream infection [CLABSI], and the remaining 15% were secondary bacteremias. The hospital wide BSI rate per 1000 discharges increased from 7.8 to 11.9 [p<0.001]. Secondary bacteremia remained relatively stable over the study period at 3/10.000 patient-days [p=0.41]. Primary BSI increased from 6.9 to 10.6 per 10.000 patient-days [p<0.001]. Hospital wide CLABSI increased from 3.2 to 6 per 1000 discharges [p<0.001] and from 7 to 11.8 per 10,000 patient-days [p=0.039]. Coagulase negative staphylococcus was the leading pathogen [23.7%] followed by Staphylococcus aureus [11.1%] and Escherichia coli [11.1%]. Of all episodes, candida caused 5%, Klebsiella pneumoniae [9%] and Pseudomonas aeruginosa [7.3%]. The rate of secondary BSI remained relatively stable over the study period. However, primary BSI and CLABSI increased over time. Coagulase negative staphylococcus, Staphylococcus aureus, and Escherichia coli were the most frequent microorganisms