Ms Kang Wei Esther Lim1, Dr Lyn-li Lim2,3, Dr Ann Bull2, Ms Judy Brett2, Ass/ Prof Leon Worth2,4
1Melbourne Medical School, University of Melbourne, Parkville, Australia
2Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute for Infection and Immunity, Melbourne, Australia
3Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
4National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne , Melbourne, Australia
Introduction: Central line-associated bloodstream infections (CLABSI) are serious healthcare-associated infections resulting in prolonged hospitalisation, increased costs and mortality. We report CLABSI burden, causative pathogens and antimicrobial susceptibility patterns in adult Intensive Care Unit (ICU) patients over a 12-year period.
Methods: Victorian public hospital ICUs have undertaken CLABSI surveillance since 2002, and in private hospitals since 2019. Data are submitted to the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre (VICNISS). Surveillance is undertaken by trained infection prevention staff using internationally accepted methods.
Results: Overall, 548 CLABSIs were reported over 948,852 device-days. Average CLABSI rates in 2010 to 2011 were 1.21/1,000 central venous catheter (CVC) days. Since 2012, CLABSI rates have been stable (mean 0.47/1,000 CVC days, range 0.27– 0.60/1,000 CVC days). Of infections, 485 (88.50%) were monomicrobial and 61 (11.13%) polymicrobial. Among 611 pathogens, Gram-positive (53.19%) were more common than Gram-negative (28.81%) and fungal (16.53%) pathogens.
Most frequently reported species were Enterococcus spp. (20.62%), coagulase-negative Staphylococcus (CoNS) (17.8%), Candida spp. (16.20%), S. aureus (11.62%) and Enterobacter spp. (4.58%).
The most common antimicrobial-resistant pathogen was vancomycin-resistant E. faecium. Prior to 2016, MRSA was the second most common antimicrobial resistant pathogen, however since 2016, MRSA has been overtaken by extended-spectrum beta-lactamase (ESBL)-producing E. coli and K. pneumoniae. Fluconazole-resistant Candida spp has only been reported since 2016.
Conclusion: Low CLABSI rates have been reported in Victorian ICUs over the last decade, however there have been changes in patterns of antimicrobial-resistance in pathogens, and this has implications for CLABSI prevention and treatment strategies.
Biography: Lyn-li Lim is an Infectious Diseases physician at VICNISS, Doherty Institute with an interest in healthcare-associated infections and antimicrobial stewardship. She is involved in the research, development of clinical guidelines and educational information in the areas of infection prevention and control.