Monitoring report

Entre le 1^er avril 2016 et le 31 mars 2017, 69 unités de soins intensifs ont participé à la surveillance des bactériémies sur cathéters centraux, pour un cumul de 135 114 jours-cathéters (tableau 1). Ces unités ont rapporté 133 bactériémies, survenues chez 125 patients. Le taux d’incidence est de 0,91 par 1 000 jours-cathéters dans les unités coronariennes, de 0,62 dans les unités universitaires adultes, de 0,46 dans les unités non universitaires adultes, de 2,16 dans les unités pédiatriques et de 2,78 dans les unités néonatales. Les taux d’incidence de 2016-2017 ont diminué par rapport aux taux de 2012-2016 dans les unités néonatales, mais ils sont demeurés stables dans les autres unités. Par rapport à 2015-2016, une unité non universitaire adulte de moins de 10 lits a cessé sa participation et deux unités coronariennes ainsi qu’une unité universitaire adulte se sont ajoutées à la surveillance. Les données ont été extraites le 5 mai 2017.

Entre le 1^er avril 2016 et le 31 mars 2017, 48 unités d’hémodialyse ont participé à la surveillance des bactériémies associées aux accès vasculaires en hémodialyse, pour un cumul de 57 570 patients-périodes (tableau 1). Ces unités ont rapporté 127 bactériémies, survenues chez 120 patients. La proportion de patients-périodes sur fistule est de 40,7 %. Le taux d’incidence est de 0,06 par 100 patients-périodes pour les patients ayant une fistule artérioveineuse, de 0,10 pour ceux ayant une fistule synthétique, de 0,32 pour ceux ayant un cathéter tunnelisé et de 1,24 pour ceux ayant un cathéter non tunnelisé. En 2016-2017, les taux d’incidence sur cathéter tunnelisé et sur cathéter non tunnelisé ont diminué significativement par rapport aux taux de 2012-2016 (p < 0,05); les taux sur fistule artérioveineuse avec trou de bouton, fistule artérioveineuse sans trou de bouton et sur fistule synthétique sont demeurés stables. Par rapport à 2015-2016, trois unités d’hémodialyse se sont ajoutées aux résultats de surveillance. Les données ont été extraites le 5 mai 2017.

From April 1^st, 2013, to March 31^st, 2014, 44 hemodialysis units took part in the surveillance of vascular access–related bloodstream infections (VARBSIs) in hemodialysis (HD) patients, for a combined total of 54,878 patient-periods (Table 1). Participating units reported 157 VARBSIs in 149 patients. Patient-periods involving a fistula accounted for 44.9% of patient-periods. The VARBSI incidence rate was 0.10 cases per 100 patient-periods for patients with an arteriovenous (AV) fistula, 0.22 for patients with a synthetic fistula (graft), 0.38 for patients with a permanent catheter and 6.20 for patients with a temporary catheter. In 2013-2014, incidence rates were stable for patients with a graft and for patients with a temporary catheter compared to 2009-2013, while incidence rates decreased significantly for patients with an AV fistula as well as patients with a permanent catheter. In 2013-2014, three HD units opened up and joined the program; one HD unit carried out the surveillance but could not report its results so these were excluded from analysis. Data was extracted on May 15, 2014. 

From April 1^st, 2013, to March 31^st, 2014, 77 healthcare facilities took part on a voluntary basis in the hospital-wide surveillance of bloodstream infections (BSIs), for a combined total of 4,149,763 patient-days (Table 1). Participating facilities reported 2,689 BSIs in 2,495 patients. The total incidence rate was 5.4 cases per 10,000 patient-days. The incidence rate in 2013-2014 was significantly lower compared with the average rate for 2009-2013 in facilities that took part in both surveillance periods. Two teaching and 11 non-teaching facilities that were not included in the 2012-2013 study joined the program in 2013-2014. Data was extracted on May 15^th, 2014. 

From April 1^st, 2013, to March 31^st, 2014, 70 intensive care units (ICUs) took part in surveillance of central line–associated bloodstream infections (CLABSIs), for a combined total of 132,376 catheter-days (Table 1). Participating ICUs reported 165 CLABSIs in 149 patients. Incidence rates were 0.65 per 1,000 catheter-days in coronary ICUs, 0.71 in teaching adult ICUs, 0.77 in non-teaching adult ICUs, 2.48 in pediatric ICUs and 4.01 in neonatal ICUs. The incidence rates in 2013‑2014 were lower compared to 2009-2013 in teaching and non-teaching adult ICUs as well as in neonatal ICUs while pediatric and coronary ICUs pooled mean rates remained statistically stable. Compared to 2012-2013, two adult non-teaching ICUs with less than 10 beds and a neonatal ICU joined the program and none discontinued their participation. Data were extracted on May 15, 2014.

From April 1^st, 2015, to March 31^st, 2016, 45 hemodialysis units took part in the surveillance of vascular access–related bloodstream infections (VARBSIs) in hemodialysis (HD) patients, for a combined total of 54,717 patient-periods (Table 1), slightly less than the preceding year. Participating units reported 136 VARBSIs in 129 patients. Patient-periods involving a fistula account for 41.0% of patient-periods. The 2015-2016 VARBSI incidence rates are 0.06 cases per 100 patient-periods for patients with an arteriovenous (AV) fistula, 0.32 for patients with a synthetic fistula (graft), 0.33 for patients with a permanent catheter and 3.34 for patients with a temporary catheter. In 2015–2016, incidence rates are significantly lower than in 2011-2015. This decrease is mainly attributable to a decrease in VARBSIs on AV fistula with buttonhole (rates per 100 patient-periods) and to a decrease of VARBSIs on permanent catheters (rate per 1,000 catheter-days). A minimum of 11 periods of data are to be provided for facilities’ data to be included in this surveillance report. Data were extracted on May 31^st, 2016.

From April 1^st, 2015, to March 31^st, 2016, 66 intensive care units (ICUs) took part in surveillance of central line–associated bloodstream infections (CLABSIs), for a combined total of 128,035 catheter-days (Table 1). Participating ICUs reported 150 CLABSIs in 139 patients. Incidence rates are 0.70 per 1,000 catheter-days in teaching adult ICUs, 0.42 in non-teaching adult ICUs, 1.95 in pediatric ICUs and 4.15 in neonatal ICUs (including cases with a mucosal barrier injury). No case is observed in coronary ICUs. Compared to 2014-2015, a coronary ICU and a teaching ICU stopped participating, while a neonatal ICU joined surveillance; one teaching and one non-teaching ICU that participated in 2014-2015 but provided less than 11 periods of data in 2015-2016, are not included in the results. A minimum of 11 periods of data are to be provided for ICUs data to be included in this surveillance report. Data were extracted on May 31^st, 2016.

From April 1^st, 2015, to March 31^st, 2016, 87 healthcare facilities took part in the hospital-wide surveillance of bloodstream infections (BSIs), for a combined total of 4,770,053 patient-days (Table 1). Participating facilities reported 3,173 BSIs in 2,948 patients. The total 2015-2016 incidence rate is 5.45 cases per 10,000 patient-days for all facilities participating in 2015-2016, and it is 5.35 for facilities that participated in 2015-2016 as well as in at least one year between 2011-2012 and 2014-2015. No non-catheter-related primary bloodstream infection (non-CRBSI) with a mucosal barrier injury (MBI) is observed in 2015-2016. The 2015-2016 incidence rate shows a decrease compared to the 2011-2015 incidence rate. A minimum of 11 periods of data are to be provided for facilities’ data to be included in this surveillance report. Data were extracted on May 31^st, 2016.

From April 1, 2015, to March 31, 2016, 95 healthcare facilities participated in the Clostridium difficile–associated diarrhea (CDAD) surveillance program, for a combined total of 5,048,411 inpatient days (Table 1). These participating facilities reported 2,977 cases of healthcare-associated CDAD (HA-CDAD). The incidence rate of HA-CDAD was 5.9 cases per 10,000 patient days. The 2015-2016 incidence rate was significantly lower than the 2014–2015 rate. The 10-day fatality rate was 8.0% (n = 219) while the 30-day fatality rate was 14.0% (n = 381). In total, 23 (0.8%) colectomies were reported. This year, two teaching facilities merged. For all results, only facilities that participated in at least 11 periods are included in the analysis. Data was extracted on May 31^st, 2016. This year, new healthcare facility categories have been defined taking into account the teaching vocation, the number of beds and the proportion of admitted patients aged 65 years or older of participating facilities. These new categories have been applied to the current surveillance period as well as to the previous years of surveillance to ensure proper comparisons.

From April 1, 2015, to March 31, 2016, 73 healthcare facilities took part in the surveillance of carbapenemase-producing Gram negative bacilli (CPGNB) infections, for a total of 3,749,277 patient days (Table 1). In total, four CPGNB infections were reported among patients who acquired their strain during a current or previous hospital stay in the reporting facility (categories 1a and 1b). The incidence rate of healthcare-associated CPGNB infection (cat. 1a and 1b) was 0.011 per 10,000 patient days. The acquisition rate of healthcare-associated CPGNB colonization (cat. 1a and 1b) was 0.197 per 10,000 patient days. Two teaching facilities and three non-teaching facilities participating last year did not participate this year whereas one teaching and nine non-teaching facilities were added. Data was extracted on May 31^st, 2016.