TY - JOUR
T1 - Unexpected hospital-acquired bacteraemia in patients at low risk of bloodstream infection
T2 - The role of a heparin drip
AU - Siegman-Igra, Y.
AU - Jacobi, E.
AU - Lang, R.
AU - Schwartz, D.
AU - Carmeli, Y.
PY - 2005/6
Y1 - 2005/6
N2 - Following a cluster of cases of unexpected hospital-acquired bacteraemia suspected to be related to an intravenous (iv) heparin drip, all cases of hospital-acquired primary bloodstream infection (BSI) in patients at low risk of bacteraemia were analysed over a four-year period. Ninety-six bacteraemic patients (6%) from 1618 episodes of hospital-acquired bacteraemia had a peripheral iv line as the only risk factor. These patients were divided into two groups: 60 patients with phlebitis and 36 without local signs of inflammation. Baseline features of the two groups were comparable, but in univariate and multivariate analysis, a significant association was found between iv heparin use, predominance of Gram-negative organisms (especially Klebsiella, Serratia and Enterobacter species), and absence of phlebitis. In spite of clear statistical association, however, the means by which the heparin solution became contaminated with Gram-negative organisms remained unknown. Following implementation of infection control methods concerning heparin handling, no more cases occurred. Unexpected hospital-acquired Gram-negative bacteraemia in patients with peripheral iv lines should prompt investigation of potential infusate-related infection, especially in patients without phlebitis and those receiving iv heparin.
AB - Following a cluster of cases of unexpected hospital-acquired bacteraemia suspected to be related to an intravenous (iv) heparin drip, all cases of hospital-acquired primary bloodstream infection (BSI) in patients at low risk of bacteraemia were analysed over a four-year period. Ninety-six bacteraemic patients (6%) from 1618 episodes of hospital-acquired bacteraemia had a peripheral iv line as the only risk factor. These patients were divided into two groups: 60 patients with phlebitis and 36 without local signs of inflammation. Baseline features of the two groups were comparable, but in univariate and multivariate analysis, a significant association was found between iv heparin use, predominance of Gram-negative organisms (especially Klebsiella, Serratia and Enterobacter species), and absence of phlebitis. In spite of clear statistical association, however, the means by which the heparin solution became contaminated with Gram-negative organisms remained unknown. Following implementation of infection control methods concerning heparin handling, no more cases occurred. Unexpected hospital-acquired Gram-negative bacteraemia in patients with peripheral iv lines should prompt investigation of potential infusate-related infection, especially in patients without phlebitis and those receiving iv heparin.
KW - Bloodstream infection
KW - Gram-negative infection
KW - Heparin infusion
KW - Hospital-acquired bacteraemia
KW - Primary bacteraemia
UR - http://www.scopus.com/inward/record.url?scp=17844383479&partnerID=8YFLogxK
U2 - 10.1016/j.jhin.2004.11.021
DO - 10.1016/j.jhin.2004.11.021
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AN - SCOPUS:17844383479
SN - 0195-6701
VL - 60
SP - 122
EP - 128
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
IS - 2
ER -