Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Sci Rep. 2022 Mar 25;12(1):5202. doi: 10.1038/s41598-022-08973-9.
Central line-associated bloodstream infections (CLABSI) cause increased morbidity, mortality, and hospital costs that are partially preventable. The phenomenon of seasonality among CLABSI rates has not been fully elucidated, but has implications for accurate surveillance and infection prevention trials. Longitudinal dynamic cohort of hospitals participating in hospital-wide and intensive care unit bloodstream infection surveillance for at least one full year over 2000 to 2014. Mixed-effects negative binomial regression analysis calculated the peak-to-low ratio between months as an adjusted CLABSI incidence rate ratio (IRR) with 95% confidence intervals (CI). Multivariate regression models examined the associations between CLABSI pathogens and ambient temperature and relative humidity. The study population included 104 hospital sites comprising 11,239 CLABSI. Regression analysis identified a hospital-wide increase in total CLABSI during July-August, with a higher gram-negative peak-to-low incidence rate ratio (IRR 2.52 [95% CI 1.92-3.30], p < 0.001) compared to gram-positive bacteria (IRR 1.29 [95% CI 1.11-1.48], p < 0.001). Subgroup analysis replicated this trend for CLABSI diagnosed in the intensive care unit. Only gram-negative CLABSI rates were associated with increased temperature (IRR + 30.3% per 5 °C increase [95% CI 17.3-43.6], p < 0.001) and humidity (IRR + 22.9% per 10% increase [95% CI 7.7-38.3), p < 0.001). The incidence and proportion of gram-negative CLABSI approximately doubled during the summer periods. Ambient temperature and humidity were associated with increases of hospital-acquired gram-negative infections. CLABSI surveillance, preventive intervention trials and epidemiological studies should consider seasonal variation and climatological factors when preparing study designs or interpreting their results.
中心静脉相关血流感染（CLABSI）会导致发病率、死亡率和医疗费用增加，部分是可以预防的。CLABSI 发生率的季节性现象尚未完全阐明，但对准确的监测和感染预防试验具有重要意义。2000 年至 2014 年，参与医院范围和重症监护病房血流感染监测至少一整年的医院的纵向动态队列。采用混合效应负二项回归分析计算了各月之间的峰值与低谷比值，作为调整后的 CLABSI 发病率比（IRR）及其 95%置信区间（CI）。多变量回归模型检验了 CLABSI 病原体与环境温度和相对湿度之间的关系。研究人群包括 104 个医院，共 11239 例 CLABSI。回归分析发现，2000 年至 2014 年，医院范围内的总 CLABSI 在 7 月至 8 月期间增加，革兰氏阴性菌的峰值与低谷发病率比（IRR 2.52 [95%CI 1.92-3.30]，p < 0.001）高于革兰氏阳性菌（IRR 1.29 [95%CI 1.11-1.48]，p < 0.001）。重症监护病房诊断的 CLABSI 亚组分析复制了这一趋势。仅革兰氏阴性 CLABSI 率与温度升高有关（IRR 每升高 5°C 增加 30.3% [95%CI 17.3-43.6]，p < 0.001）和湿度（IRR 每升高 10%增加 22.9% [95%CI 7.7-38.3]，p < 0.001）。夏季期间，革兰氏阴性 CLABSI 的发病率和比例增加了约一倍。环境温度和湿度与医院获得性革兰氏阴性感染的增加有关。CLABSI 监测、预防干预试验和流行病学研究在设计研究方案或解释结果时，应考虑季节性变化和气候因素。
