ReviewEpidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates
Introduction
Bloodstream infections, which includes catheter-related bloodstream infections (CRBSI), are a costly subset of nosocomial infection (NI) associated with a poor prognosis and high costs.1 Approximately 80% of primary bacteraemia are related to the positioning of central venous catheters (CVCs) that are commonly used in modern medicine.2 CRBSIs burden-of-illness data are relatively scarce and heterogeneous from one country to another. Our objective was to estimate the epidemiology, clinical outcomes and costs associated with CRBSIs in four European countries (France, Germany, Italy and the UK) based on recent information.
Section snippets
Methods
We performed a Medline literature review of published epidemiological studies, economic evaluations and cost studies in the field of CRBSIs. The review combined the following terms: ‘nosocomial infections’ or ‘bloodstream infections’ or ‘CRBSI’ and ‘epidemiology’ or ‘incidence’ or ‘costs’ or ‘outcomes’ or ‘mortality’ and ‘France’ or ‘United Kingdom’ or ‘Germany’ or ‘Italy’ and was performed in November 2007. The terms were searched in all fields of the summary and no restriction was used on the
Results
More than 50 articles and documents were identified for the four countries and were extensively analysed. In a second step, we rejected references considered outdated as more recent data were identified during the literature search process. The estimates and references were reviewed and validated by national experts and used for the calculation if considered appropriate.
Table I summarises the key findings of this analysis. Figure 1 presents the minimum and maximum estimates per country for the
Discussion
One limit of our study is explained by the literature review method, which only searched in the Medline database. We attempted to control this bias by interviewing clinical experts, who would be aware of grey literature and articles that were initially not retrieved.
Overall, the analysis confirms that CRBSI is a serious medical issue that creates significant medical and economic burden for the healthcare systems.
From a medical standpoint, the large variation of CRBSI rates across countries (
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