Infection Control & Hospital Epidemiology (2018), 39, 1202–1209 doi:10.1017/ice.2018.185
Original Article
A ten-year review of healthcare-associated bloodstream infections from forty hospitals in Québec, Canada
Iman Fakih1, Élise Fortin2,3, Marc-André Smith4, Alex Carignan5, Claude Tremblay6, Jasmin Villeneuve2, Danielle Moisan7, Charles Frenette8, Caroline Quach1,2,3,9 and for SPIN-BACTOT 1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada, 2Direction des risques biologiques et de la santé au travail,
Institut national de santé publique du Québec, Québec, Canada, 3Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Québec, Canada, 4CIUSSS du Nord-de-l’Île-de-Montréal, Québec, Canada, 5Department of Microbiology and Infectious Diseases, Sherbrooke University, Québec, Canada, 6CHU de Québec, Québec, Canada, 7CISS du Bas-Saint-Laurent, Québec, Canada, 8Department of Medical Microbiology, McGill University Health Centre, Québec, Canada and 9Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Québec, Canada
Abstract
Objective: Healthcare-associated bloodstream infections (HABSI) are a significant cause of morbidity and mortality worldwide. In Québec, Canada, HABSI arising from acute-care hospitals have been monitored since April 2007 through the Surveillance des bactériémies nosocomiales panhospitalières (BACTOT) program, but this is the first detailed description of HABSI epidemiology. Methods: This retrospective, descriptive study was conducted using BACTOT surveillance data from hospitals that participated continuously between April 1, 2007, and March 31, 2017. HABSI cases and rates were stratified by hospital type and/or infection source. Temporal trends of rates were analyzed by fitting generalized estimating equation Poisson models, and they were stratified by infection source. Results: For 40 hospitals, 13,024 HABSI cases and 23,313,959 patient days were recorded, for an overall rate of 5.59 per 10,000 patient days (95% CI, 5.54–5.63). The most common infection sources were catheter-associated BSIs (23.0%), BSIs secondary to a urinary focus (21.5%), and non–catheter-associated primary BSIs (18.1%). Teaching hospitals and nonteaching hospitals with ICUs often had rates higher than nonteaching hospitals without ICUs. Annual HABSI rates did not exhibit statistically significant changes from year to year. Non–catheter- associated primary BSIs were the only HABSI type that exhibited a sustained change across the 10 years, increasing from 0.69 per 10,000 patient days (95% CI, 0.59–0.80) in 2007–2008 to 1.42 per 10,000 patient days (95% CI, 1.27–1.58) in 2016–2017. Conclusions: Despite ongoing surveillance, overall HABSI rates have not decreased. The effect of BACTOT participation should be more closely investigated, and targeted interventions along alternative surveillance modalities should be considered, prioritizing high-burden and potentially preventable BSI types.
(Received 21 May 2018; accepted 12 July 2018; electronically published August 29, 2018)
Healthcare-associated bloodstream infections (HABSIs) are a significant cause of morbidity and mortality worldwide. Recent multicenter studies in Europe, the United States, and Australia have reported HABSI incidence rates for acute-care inpatients ranging between 6 and 21 cases per 10,000 patient days,1–3 with case fatality rates between 12% and 31%.4,5 Estimates from Canada are limited to point-prevalence studies,6,7 which are subject to seasonality and time-dependent bias because they assume the population at risk is at a steady state and because they oversample sicker patients with longer lengths of stay.8–10 Accu- rate estimates of HABSIs are necessary to assess disease burden, to benchmark and cross-comparison across facilities and jur- isdictions, and ultimately, to improve patient care and safety. In Québec, Canada, HABSIs have been monitored in acute-
care hospitals since April 1, 2007, by the Surveillance provinciale des infections nosocomiales (SPIN; Provincial Nosocomial
Author for correspondence: Caroline Quach, CHU Sainte-Justine, 3175 ch Côte Sainte-Catherine, Suite B.17.102, Montréal, QC H3T 1C5. E-mail:
c.quach@umontreal.ca
Cite this article: Fakih I, et al. (2018). A ten-year review of healthcare-associated bloodstream infections from forty hospitals in Québec, Canada. Infection Control & Hospital Epidemiology 2018, 39, 1202–1209. doi: 10.1017/ice.2018.185
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
Infection Surveillance) through the Surveillance des bactériémies nosocomiales panhospitalières (BACTOT) program. BACTOT differs from most HABSI surveillance programs by monitoring all acute-care HABSIs, regardless of infection source or ward type. March 31, 2017, marked the completion of 10 years of BACTOT surveillance, and only 1 peer-reviewed article focusing on HABSI secondary to a urinary focus has been published so far.11 This article provides a descriptive epidemiological presentation of BACTOT surveillance data from hospitals that have participated continuously for 10 years, describing the overall and source- specific incidence rates of HABSIs and their temporal changes.
Methods Data collection
Beginning on April 1, 2007, SPIN required all voluntarily parti- cipating hospitals to perform active facility-wide surveillance of HABSIs, excluding psychiatric wards, long-term care, and nur- series. On April 1, 2013, participation in BACTOT became mandatory province-wide for all hospitals with >1,000
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