Background. Hospital acquired bloodstream infection (HABSI) due to Staphylococcus aureus (SA) causes infectious complications in hospitalized patients. We assessed the outcomes of primary SA HABSIs that meet and do not meet the NHSN CLABSI definition.
Methods. Cases of primary SA HABSI were identified using an infection prevention surveillance database from January 1, 2010 to December 31, 2013 and categorized as being CLABSI or non-CLABSI (nCLABSI) according to NHSN definitions. The electronic medical record was reviewed to obtain clinical variables. Complicated bacteremia was defined as the presence of: septic thrombophlebitis, cardiac device infections, vertebral osteomyelitis, or infective endocarditis. Primary outcomes were mortality at 30 days and 1 year, septic thrombophlebitis, cardiac device infection, vertebral osteomyelitis, infective endocarditis, and complicated bacteremia.
Results. CLABSI and nCLABSI infections numbered 78 and 44, respectively, and are described in the table. 26 nCLABSI infections were associated with a peripheral IV (16) or a midline catheter (10). Mean time from admission to first positive culture was shorter for nCLABSI infections (6 vs 16.3 days; p = <0.001). The Charlson Comorbidity Indices, rate of ID consultation, 30 day and 1 year mortality were not different between the groups.
Comparison of CLABSI vs nCLABSI using Univariate Cox Proportional Hazards
| CLABSI |
Non-CLABSI |
||||
|---|---|---|---|---|---|
| Variable | Number | Percent of CLABSI Cohort | Number | Percent of Non-CLABSI Cohort | P-value |
| Male | 44 | 56.4% | 25 | 56.8% | 0.97 |
| Evidence of PIV Infection | 0 | 0% | 16 | 20.4% | <0.001 |
| Midline Placement Prior to Infection | 3 | 3.8% | 10 | 22.7% | 0.002 |
| MRSA | 38 | 48.7% | 19 | 43.2% | 0.56 |
| Septic Thrombophlebitis | 17 | 21.8% | 18 | 40.9% | 0.025 |
| Vertebral Osteomyelitis | 0 | 0% | 2 | 4.6% | 0.13 |
| Infective Endocarditis | 0 | 0% | 3 | 6.8% | 0.046 |
| Operation for Bacteremia | 0 | 0% | 4 | 9.1% | 0.016 |
| Cardiac Device Infections | 0 | 0% | 3 | 2.3% | 0.045 |
| Complicated Bacteremia | 17 | 20.8% | 22 | 50% | 0.001 |
Conclusion. Primary SA nCLABSIs are a substantial clinical problem with more complications and similar mortality when compared to SA CLABSIs. Explanations may include decreased vigilance regarding source of infection, lack of a removable focus, and midline catheter usage. Focused practice improvement is necessary to prevent morbidity related to primary SA BSI even in the absence of a central-venous catheter.
Disclosures. All authors: No reported disclosures.