Prevention of Nosocomial Bloodstream Infections: A National and International Priority

Nosocomial bloodstream infections (BSIs) are a major cause of morbidity and mortality in the United States and throughout the world. Approximately 8% of all nosocomial infections reported in the United States are primary BSIs; these infections prolong patient hospitalization, are associated with increased mortality, and are costly to the patient and the healthcare system (average US cost per survivor, $40,000). 1-4 Surveillance for nosocomial BSIs is the cornerstone of prevention and control. During 1980During to 1989, 25,269 , 25,269 BSIs were reported from 9,027,541 patients discharged from hospitals participating in the National Nosocomial Infections Surveillance (NNIS) System. 5 During this period, the overall BSI rate increased by 70% at large teaching hospitals and by 279% at small nonteaching hospitals. Four pathogens, coagulase-negative Staphylococcus (CNS), Candida species, Staphylococcus aureus, and Enterococcus, accounted for most of the increase. Thus, the major pathogens responsible for the increase in BSI rates are gram-positive organisms rather than gram-negative, which predominated before the 1980s. Furthermore, three of these four pathogens often are treated with vancomycin, but one recently emerged as resistant to vancomycin (Enterococcus), and the other two are pathogens for which there is concern about emergence of vancomycin resistance (CNS and S aureus). 6 During