Research for infection protection

Abstract: Clinical importance of vascular catheter-associated infections in Germany: Small cause, big effect?

Nosocomial infections (NI) belong to the most common complications of a hospital stay. The clinic-wide ALERTS study of the Integrated Research and Treatment Centre for Sepsis Control & Care at the University Hospital of Jena, Germany aims at reducing nosocomial infections.

Over a period of four years, around 75 000 patients of the clinic are recorded and systematically examined for hospital-acquired infections. Further elements of ALERTS are comprehensive infection control training measures and the evaluation of the effect of these measures in order to reduce the NI rate by 20 %. The study’s extent is unique, since only individual measures and special patient groups had been investigated before.

Intermediate results from the first ALERTS surveillance period provide data from 30 631 patients. The most frequent nosocomial infections in the study include surgical site infection (28 %), infection of the lower respiratory tract (25 %), primary sepsis (13 %) and symptomatic urinary tract infection (11 %)

Worth mentioning is the high number of cases of nosocomial infections involving a progression from a local infection to a severe bloodstream infection or to a septic shock. When looking at the NI that are particularly severe, venous catheter-associated primary bloodstream infection ranks second with 33 %.

Previously, the focus was on central venous catheters (CVCs) as cause of primary sepsis. Recent data suggest that both the share and the severity of nosocomial infections associated with peripheral venous catheters (PVCs) has been underestimated. According to a recent Spanish study, the rate of PVC-associated infections was 0.19 cases/1 000 patient-days compared to 0.18 cases/1 000 patient-days caused by CVCs.

Compared to CVC-associated infections, the time between the insertion and the occurrence of the bacteraemia was shorter with CVC-associated infections (4.9 vs. 15.4 days). And the share of detected Staphylococcus aureus was higher (43 % vs. 33 %). Additionally, patients with PVC-associated infections had a higher rate of complicated bacteraemia (7 %) and a higher mortality (27 %).

Especially immunocompromised patients are at risk of developing an infection caused by a PVCs, as shown by the casuistry of a patient who died from a sepsis after a PVC-associated abscess due to E. faecalis.

Speech by Prof. Dr. med. Frank Martin Brunkhorst, University Hospital of Jena, Germany, Centre for Clinical Studies, Paul-Martini Research Group for Clinical Sepsis Research, Clinic for Anaesthesiology and Intensive Care. Lunchtime Symposium: Simple Processes – Improved Hygiene. New research results to protect patients in daily hospital routine, Berlin, Germany, 19 September 2013, arranged by the BODE SCIENCE CENTER, Hamburg, Germany, scientific centre of excellence of PAUL HARTMANN AG, Heidenheim, Germany.