The Risk of Bloodstream Infections in Patients with Central Venous Access Port in Non-ICUs in Germany

Background / Question

Catheter-related bloodstream infections (CR-BSI) are one of the most common complications of central venous access ports. There is a lack of evidence on CR-BSI rates in patients with such ports in hospital and outpatient settings. We analyzed national surveillance data and reported incidence densities of CR-BSI in patients with central venous access ports and central venous catheters in non-intensive care units (Non-ICUs) in Germany.

Methods

Surveillance of hospital-acquired infections in Non-ICUs is performed in the STATIONS-KISS module, www.nrz-hygiene.de. Non-ICUs that had collected data on patients with central venous access ports and central venous catheters for at least one month were included in the present analysis. We calculated incidence densities of port-related BSI from 2011 to 2021 and compared these rates with CVC-related bloodstream infection rates.

Results

A total of 268 port-related BSI were documented from 2011 to 2021 in 118 participating Non-ICUs. The overall incidence density for port-related BSI was 0.67 per 1000 device-days in patients with central venous access port. The utilisation rate of central venous access ports has remained relatively stable over the years and is around 18.79 per 100 patient-days. Facility-based BSI rates differed only slightly between internal medicine, oncohaematology, interdisziplinary, surgical and neurological facilities. Compared to patients with central venous access port, patients with CVC had a 3-fold higher risk of bloodstream infection in our cohort (0.67 versus 2.16 per 1000 device-days). The most commonly isolated pathogens were coagulase-negative staphylococci and staphylococcus aureus, however, gram-negative microorganisms, including Klebsiella pneumonia, were also prevalent.

Conclusions

Our results are consistent with previous international studies, which showed CR-BSI rates between 0.11 and 0.76 per 1000 device-days in patients with central venous access ports. Given the increasing use of such vascular access devices in hospital and outpatient settings, infection prevention bundles are needed to reduce the risk of bloodstream infections.