P-1160. Hospital-Onset Bacteremia as a Surveillance Tool: A Comparative Analysis with CLABSI Rates

TL;DR

This study compares two measures of hospital-acquired blood infections and finds they are not strongly correlated.

Contribution

It evaluates HOBSI as a potential alternative to CLABSI for tracking hospital infections.

Findings

There was a low, non-significant correlation between HOBSI and CLABSI rates (R=0.30; p=0.343).

HOBSI rates showed an increasing trend while CLABSI rates decreased during the study period.

Both HOBSI and CLABSI rates were low, with 91 and 14 cases respectively over the study period.

Abstract

Hospital-acquired infections (HAIs) are the most frequent cause of nosocomial adverse effects in the United States. In 2009, the Department of Health and Human Services developed an action plan to eliminate HAIs which includes monitoring the rates of six nosocomial infections including central line-associated bloodstream infections (CLABSIs). The focus on these measures has resulted in a decreased incidence of nosocomial blood stream infections, but the measures are labor-intensive, subject to ceiling effects, and do not reflect the full burden of hospital-acquired blood stream infections. Given these limitations, hospital-onset blood stream infection (HOBSI), defined as the growth of a recognized bacterial or fungal pathogen from a blood culture specimen collected on or after the fourth day of hospital admission, has been proposed as an alternate measure of nosocomial blood-stream infections. In a prior study, HOBSI rate correlated with CLABSI rate making this a possible surrogate marker for CLABSI.CLABSI & HOBSI Correlation Analyses South Texas VHA

CLABSI & HOBSI Correlation Analyses South Texas VHA

This was a prospective review of all blood cultures positive for non-commensal organisms on day 4 or later of admission for patients hospitalized at the Audie L. Murphy VA between January 1, 2022 and December 31, 2024. Trends in HOBSI rates per 1000 bed days of care and CLABSI rates per 1000 central line days were described quarterly throughout the study period. The relationship between HOBSI and CLABSI was evaluated using Pearson correlation.

There were 91 total HOBSI and 14 CLABSI during the period reviewed. There was a trend towards an increase in HOBSI rates and decreasing CLABSI rates, with significant variability over time resulting in low R2 values.

There was a low, non-significant correlation between CLABSI and HOBSI rates (R=0.30; p=0.343).

HOBSI surveillance has been proposed as an alternate nosocomial blood-stream surveillance measure that would be easier to automate and would provide data on hospital-acquired blood stream infections beyond CLABSIs. In our study, there was not a significant correlation between HOBSI and CLABSI rates, but rates of both were low. Further research is needed into whether HOBSI surveillance should be adopted as part of our standard HAI surveillance measures.

Kelly R. Reveles, PharmD, PhD, AstraZeneca: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant

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