Research for infection protection

Interview: “A third of the patients with venous catheter-associated infections develops as severe bloodstream infection”

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
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

Three questions to 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.


What role do vascular catheter-associated bloodstream infections play in the general context of nosocomial infections?
    
Frank Martin Brunkhorst: According to the intermediate results of our first ALERTS* surveillance period, the share of primary sepsis in the documented nosocomial infections is 13 %. However, it is not only the frequency, but also the severity of these infections that is of foremost importance. When looking at the nosocomial infections that are particularly severe, primary bloodstream infection ranks second with 33 %. A third of the vascular catheter-associated infections has a severe course, starting with a local infection and developing into a severe sepsis or septic shock.


A case report that you and Frosinski just recently published demonstrates how severe venous catheter-associated infections can be. What had happened?

Frank Martin Brunkhorst: The herpes zoster with meningoencephalitis of an 82-year-old immunocompromised man was treated with an antibiotic administered via a peripheral venous catheter (PVC) in an external neurological clinic. While the meningoencephalitis healed up, the patient developed a catheter-associated phlebitis in the right elbow pit during the in-patient stay, which then progressed to a sepsis with fatal consequences. The death can be attributed to mistakes in the hygiene and infection management, although there are evidence-based recommendations. The PVC insertion site in the elbow pit, for example, was not suitable, microbiological diagnostic did not happen, the signs of the sepsis were not recognised, and a resistance-based treatment with antibiotics was initiated too late.


Starting point of this dramatic case was a PVC – a rather simple routine measure. Have the risks emanating from these catheters been underestimated up to now?

Frank Martin Brunkhorst: In fact, so far, national and international surveillance systems mainly recorded infections due to central venous catheters (CVCs). In contrast, reference data for PVCs are hardly available. A recent Spanish study recorded 0.19 cases of PVC-associated bloodstream infections per 1 000 patient-days compared to 0.18 cases per 1 000 patient-days due to CVCs. Consequently, the case numbers for PVCs are higher. Furthermore, the mortality among patients with PVC-associated infections is higher compared to those with CVC-associated infections. When considering that the PVC is used much more often in clinical routine, it is imperative to considerably raise the awareness of infections caused by PVCs.


* Hospital-wide infection control programme to reduce the incidence of nosocomial infection and associated cases of bloodstream infection (ALERST)


Source:
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.