Primary bloodstream infection

Vascular access is one of the most common medical measures in hospitals. Each year, around 300 million intravascular catheters are placed in patients in the United States alone – approximately 3 million of these are central venous catheters (CVCs), which cause 90 per cent of all primary bloodstream infections (BSIs).

Most of these infections occur in patients with short-term CVCs. Depending on the type of ward/surgery, infection rates vary between 1.3 per 1 000 catheter days in inpatient medical/surgical wards to 5.6 per 1 000 catheter days in burn ICUs*.

To ensure consistent diagnosis of primary BSI – for surveillance for instance – the CDC case definitions are used**:

The infection meets at least one of the following criteria:

1. Pathogen cultured from blood is not related to an infection at another site.
   
   
2. Patient shows at least one of the following signs or symptoms: fever (> 38 °C), chills, or hypotension and signs and symptoms and positive laboratory results are not related to an infection at another site
   
   and
   
   common skin contaminant is cultured from two or more blood cultures drawn on separate occasions.

“B2 Clinical primary BSI” may be used only to report primary BSI in neonates and infants ? 1 year of age.

The infection risk is influenced by several factors, for example the patient’s immune status. Hence, it is not possible to prevent all intravascular catheter-related primary BSIs. However, compliance with evidence-based recommendations significantly contributes to reducing the infection risk.

Recommendations on preventing primary bloodstream infection

• Empfehlung Prävention Gefäßkatheter-assoziierter Infektionen. (Recommendation on preventing intravascular catheter-related infections)
  Kommission für Krankenhaushygiene am Robert Koch-Institut (Commission for Hospital Hygiene and Infection Prevention at the Robert Koch-Institute), 2002.
  
  Please click here to download the PDF (in German)

• Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America.
  
  Please click here to download the PDF

*O'Grady NP, Chertow DS
Managing bloodstream infections in patients who have short-term central venous catheters. Cleveland Clinic Journal of Medicine January, 2011, 78 (1): 10-17.

** 7th edition of the definitions of nosocomial infection (CDC definitions). Robert Koch-Institute, 10 February 2011