Increase in the frequency of catheter-related bloodstream infections during the COVID-19 pandemic: a plea for control

Scientific publication: Perez-Granda M.J., Carillo C.S, Rabadàn P.M., et.al J Hosp Infect. 2021 Oct 8:S0195-6701(21)00347-9. doi: 10.1016/j.jhin.2021.09.020.

Introduction 

The COVID-19 pandemic has resulted in a huge increase in the workload of hospital staff.¹ Caring for patients in such circumstances can be challenging and therefore, it is not surprising that some centres have reported an increase in nosocomial infections like ventilator-associated pneumonia and bacteraemia.¹ However, the effect of the COVID-19 pandemic on other nosocomial infections like catheter-related bloodstream infections (CR-BSIs) is still unknown. 

In this study, the authors have attempted to measure the impact of the COVID-19 pandemic on the occurrence of catheter-related bloodstream infections (CR-BSIs) in a large Spanish hospital. 

Methodology 

The authors performed a retrospective study in which they compared the incidence, aetiology and outcome of CR-BSIs from March to May in 2019 and 2020 (before and during the pandemic). The primary endpoint was defined as the incidence of CR-BSI episodes before and during the pandemic. The aetiology and consequences of CR-BSI during the first wave of the pandemic were considered secondary endpoints.  

The authors defined CR-BSI as the presence of bacteraemia or fungaemia in a patient with clinical manifestation of infection and no other apparent source of bloodstream infection (except for a catheter). A catheter tip culture, quantitative or semi-quantitative, positive for the same micro-organism was also required.  

Study results 

Hospital admissions and CR-BSI data 

The total number of hospital admissions during the study period were 12,111 (Mar to May 2019) and 10,479 (Mar to May 2020). The number of episodes of significant bloodstream infections was 358 (29.55/1000 admissions) and 379 (36.16/1000 admissions) in the three months in 2019 and 2020, respectively. 

The authors report that the number of patients with one or more CR-BSIs increased significantly to 58 in 2020 (pandemic), compared to 23 in 2019 (pre-pandemic). The number of CR-BSI episodes during the study period increased from 24 in 2019 to 65 in 2020. The proportion of CR-BSIs from all significant episodes of bloodstream infections also rose from 6.7% (2019) to 17.1% (2020).¹ 

 COVID-19 patient specifics 

 A high proportion (77.58%) of the CR-BSI cases in 2020 occurred in COVID-19 patients, and the vast majority of the episodes (91.37%) happened during their stay in the intensive care unit (ICU). The length of the median stay in the ICU was also higher for patients with CR-BSI in 2020 compared with 2019 (35.0 (17.0 – 59.7) vs 17.0 (0.0 – 52.0)).  

Author conclusions 

According to the authors, the results demonstrate a substantial quantitative and qualitative impact of the COVID-19 pandemic on CR-BSIs, with the incidence increasing at least three-fold during the first three months of the pandemic at their institution. They believe that even though their data was confined to just one hospital, it appropriately quantifies a problem that is widespread all across the world. The authors urge healthcare professionals to immediately enforce control measures against nosocomial infections,  stating that the figures should and can be lowered. 

References