In 2014–2015, incidence rates were 0.34 per 1,000 catheter-days in coronary ICUs, 0.52 in teaching adult ICUs, 0.76 in non-teaching adult ICUs, 2.06 in pediatric ICUs and 2.20 in neonatal ICUs. The lowest pooled mean rate was found in coronary ICUs (Table 2). The CLABSI incidence rate was highest in neonatal and pediatric ICUs, and these rates were significantly higher than that of adult ICUs (p < 0.01).

Table 2 – CLABSI Incidence Rate and Catheter Utilization Ratio, by Type of Healthcare Facility and Type of ICU, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days [95% CI])

95% CI: 95% confidence interval.

In 2014–2015, six neonatal ICUs provided the number of catheter-days by birth weight category showing that incidence rates tend to be higher in the lowest birth weight categories (Table 3).

Table 3 – CLABSI Incidence Rate in Neonatal ICUs, by Birth Weight Category, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days [95% CI])

In 2014–2015, compared to the previous four years (Figure 1), CLABSI incidence rates declined significantly in adult teaching ICUs (p < 0.01) and neonatal ICUs (p < 0.01), but remained stable in adult non-teaching ICUs (p > 0.05), pediatric ICUs (p > 0.05) and coronary ICUs (p > 0.05).

Figure 1 – CLABSI Incidence Rate, by Type of Healthcare Facility and Type of ICU, in ICUs that previously participated in SPIN (N = 67), Québec, 2010–2014 and 2014–2015 (Incidence Rate per 1,000 Catheter-days [I.C. 95%])

In addition to the marked decrease of CLABSI rates, a significant increase (p < 0.05) of catheter utilization ratios was observed in neonatal ICUs. The catheter utilization ratio decreased significantly in other ICUs (Figure 2).

Figure 2 – Catheter Utilization Ratio, by Type of Healthcare Facility and Type of ICU, in ICUs that previously participated in SPIN (N = 67), Québec, 2010–2014 and 2014–2015

Patients who developed a CLABSI were aged between 0 and 87 years, with a median age of 67 years in the adult ICUs, 0.6 years in pediatric ICUs and a little less than one month of age in neonatal ICUs. In adult ICUs, the central lines most frequently associated with bloodstream infections were the 'other' central venous catheters (CVCs) that included central lines previously named 'regular' CVCs, followed by peripherally inserted central catheters (PICCs) (Figure 3). In neonatal ICUs, PICCs were the CVCs most associated with CLABSI, followed by umbilical catheters.

Figure 3 – Type of Central Line Used in CLABSI Cases, by Type of Healthcare Facility and Type of ICU, Québec, 2014–2015 (N)

NB: More than one central line may be reported in any given case of CLABSI, which explains why the total number of central lines is higher than the total number of CLABSIs presented earlier in this paper.

In 2014–2015, 19% of CLABSI cases died in the 30 days following bacteremia onset (Table 4). Case fatality was 100% in coronary ICUs (Table 4) but the number of cases was very small. The overall case fatality of 19% is not a significant increase compared to the case fatality of 16% observed in 2013–2014 (p > 0.05).

Figure 4 – 30-Day Case Fatality, by Type of Healthcare Facility and Type of ICU, Québec, 2014–2015 (%)

Table 4 – 30-Day Case Fatality, by Type of Healthcare Facility and Type of ICU, Québec, 2014–2015 (N, %)

Figure 5 shows that the microorganisms most frequently isolated in reported CLABSI cases were coagulase-negative staphylococci (CoNS, 38%), followed by Enterococcus sp. (13%) and S. aureus (13 %). However, CoNS and Candida sp. were present in almost two thirds of cases resulting in death (61%).

Figure 5 – Categories of Isolated Microorganisms in All Cases (N = 133) and Cases of Mortality Within 30 Days (N = 26), Québec, 2014–2015 (%)

Isolated Microorganisms – All Cases

Isolated Microorganisms – Mortality Within 30 Days

In 2014–2015, 12% of S. aureus strains were resistant to oxacillin; 26% of Gram-negative bacteria showed resistance to piperacillin/tazobactam. One vancomycin-resistant Enterococcus was reported, for a proportion of resistant enterococci of 6% (Table 5 and Figure 6).

Table 5 – Percentage of Strains Tested and Percentage of Resistance to Antibiotics for Certain Isolated Microorganisms, Québec, 2014–2015 (N, %)

CSE 4: cefepime, cefotaxime, ceftazidime or ceftriaxone; CSE 2: cefepime or ceftazidime.
Fluoroquinolones 2: ciprofloxacin or levofloxacin;
Fluoroquinolones 3: ciprofloxacin, levofloxacin or moxifloxacin;
Multiresistant 1: intermediate or resistant to an agent in three of the following five categories: cephalosporins 4, fluoroquinolones 3, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam.
Multiresistant 2: intermediate or resistant to an agent in three of the following five categories: cephalosporins 2, fluoroquinolones 2, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam.
Multiresistant 3: intermediate or resistant to an agent in three of the following six categories: cephalosporins 2, fluoroquinolones 2, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam, ampicillin/sulbactam.

Figure 6 – Antibiotic Resistance in Gram-Positive Bacteria, Gram-Negative Bacteria and Pseudomonas sp., Québec, 2010–2014 to 2014–2015 (%)

In 2014–2015, all participating coronary, adult teaching, pediatric and neonatal ICUs remained below the 90th percentile from the 2010–2011 to 2013–2014 rates, which suggests an improvement in CLABSI rates (Figures 7, 8, 10 and 11). Only one adult non-teaching ICU ranked above the 90th percentile in its respective category: less than 10% of ICUs, figure 9. Tables 6 and 7 present the numerical values that correspond to rates displayed in Figures 7 to11. Tables 8 and 9 show the catheter utilization rates for each ICU.

Figure 7 – CLABSI Incidence Rate per ICU (2014–2015) and Percentile Ranking (2010–2011 to 2013–2014), Coronary ICUs, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days)

Figure 8 – CLABSI Incidence Rate per ICU (2014–2015) and Percentile Ranking (2010–2011 to 2013–2014), Teaching Adult ICUs, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days)

Figure 9 – CLABSI Incidence Rate per ICU (2014–2015) and Percentile Ranking (2010–2011 to 2013–2014), Non-Teaching Adult ICUs, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days)

Figure 10 – CLABSI Incidence Rate (2014–2015) and Percentile Ranking (2010–2011 to 2013–2014) per ICU, Pediatric ICUs, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days)

Figure 11 – CLABSI Incidence Rate (2014–2015) and Percentile Ranking (2010–2011 to 2013–2014), per ICU, Neonatal ICUs, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days)

Table 6 – CLABSI Incidence Rate per ICU, Distribution of CLABSI rates for 2010–2014 and the Ministry’s Strategic Planning Threshold, by ICU Types, for Teaching Healthcare Facilities, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days)

* In healthcare facilities with more than one type of adult ICU: S = surgical, M = medical, X = mixed and B = burn trauma..
** This threshold represents the 90th percentile for 2007–2009 rates

Table 7 – CLABSI Incidence Rate per ICU, Distribution of CLABSI rates for 2010–2014 and the Ministry’s Strategic Planning Threshold, by ICU Types, for Non-teaching Healthcare Facilities, Québec, 2014–2015 (Incidence Rate per 1,000 Catheter-days)

*This threshold represents the 90th percentile for 2007–2009 rates.

Table 8 – Catheter Utilization Ratio per ICU, Distribution of Ratios for 2010–2014, by ICU Types, for Teaching Healthcare Facilities, Québec, 2014–2015

* In healthcare facilities with more than one type of adult ICU: S = surgical, M = medical, X = mixed and B = burn trauma.

Table 9 – Catheter Utilization Ratio per ICU, Breakdown for 2010–2014, by ICU Types, for Non-teaching Healthcare Facilities, Québec, 2014–2015

Comité de surveillance provinciale des infections nosocomiales (SPIN) – bactériémies sur cathéters centraux aux soins intensifs

Editorial Committee 

Élise Fortin, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Muleka Ngenda-Muadi, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Caroline Quach, Centre universitaire de santé McGill, Hôpital de Montréal pour enfants

Mélissa Trudeau, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec