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The Burden of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection among Hematology, Oncology, and Stem Cell Transplant Patients

  • Kristen E. Metzger (a1), Yvonne Rucker (a2), Mary Callaghan (a2), Michelle Churchill (a2), Borko D. Jovanovic (a3), Teresa R. Zembower (a1) (a4) and Maureen K. Bolon (a1) (a4)...



To evaluate the impact and burden of the new National Healthcare Safety Network surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), in hematology, oncology, and stem cell transplant populations.


Retrospective cohort study.


Two hematology, oncology, and stem cell transplant units at a large academic medical center.


Central line–associated bloodstream infections (CLABSIs) identified during a 14-month period were reviewed and classified as MBI-LCBI or non-MBI-LCBI (MBI-LCBI criteria not met). During this period, interventions to improve central line maintenance were implemented. Characteristics of patients with MBI-LCBI and non-MBI-LCBI were compared. Total CLABSI, MBI-LCBI, and non-MBI-LCBI rates were compared between baseline and postintervention phases of the study period.


Among 66 total CLABSI cases, 47 (71%) met MBI-LCBI criteria. Patients with MBI-LCBI and non-MBI-LCBI were similar in regard to most clinical and demographic characteristics. Between the baseline and postintervention study periods, the overall CLABSI rate decreased from 3.37 to 3.21 infections per 1,000 line-days (incidence rate ratio, 0.95; 4.7% reduction, P=.84), the MBI-LCBI rate increased from 2.08 to 2.61 infections per 1,000 line-days (incidence rate ratio, 1.25; 25.3% increase, P=.44), and the non-MBI-LCBI rate decreased from 1.29 to 0.60 infections per 1,000 line-days (incidence rate ratio, 0.47; 53.3% reduction, P=.12).


Most CLABSIs identified among hematology, oncology, and stem cell transplant patients met MBI-LCBI criteria, and CLABSI prevention efforts did not reduce these infections. Further review of the MBI-LCBI definition and impact is necessary to direct future definition changes and reporting mandates.

Infect Control Hosp Epidemiol 2014;00(0): 1–6


Corresponding author

Address correspondence to Kristen E. Metzger, MPH, CIC, Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, 645 N. Michigan Ave., Suite 900, Chicago, IL 60611 (


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Present affiliation: Palliative Care Division, NorthShore University Health System, Glenview, Illinois [M. Churchill].

Presented in part: Association of Professionals in Infection Control and Epidemiology Annual Conference; Anaheim, CA; June 7, 2014 (Abstract 413).



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1. Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976981.
2. Warren, DK, Quadir, WW, Hollenbeak, CS, Elward, AM, Cox, MJ, Fraser, VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med 2006;34:20842089.
3. Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391402.
4. Elward, AM, Hollenbeak, CS, Warren, DK, Fraser, VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2005;115:868872.
5. Centers for Disease Control and Prevention. Operational guidance for acute care hospitals to report central line-associated bloodstream infection (CLABSI) data to CDC’s NHSN for the purpose of fulfilling CMS’s Hospital Inpatient Quality Reporting (IQR) requirements. Available at: Accessed October 11, 2013.
6. Steinberg, JP, Robichaux, C, Chernetsky Tejedor, S, Dent Reyes, M, Jacob, JT. Distribution of pathogens in central line-associated bloodstream infection among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013;34:171175.
7. Steinberg, JP, Coffin, SE. Improving the central line-associated bloodstream infection surveillance definition: a work in progress. Infect Control Hosp Epidemiol 2013;34:777779.
8. Pehar, M, Ristaino, P, Budd, AP, et al. Application of the National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLA-BSI) definition to oncology patients: impact in the trenches. Presented at Fifth Decennial Conference on Healthcare-Associated Infections; Atlanta, Georgia; March 18-22, 2010 (Abstract 660).
9. Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central-line associated bloodstream infections: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31:12861289.
10. Fraser, TG, Gordon, SM. CLABSI rates in immunocompromised patients: a valuable patient centered outcome? Clin Infect Dis 2011;52:14461450.
11. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter–related infections. Am J Infect Control 2011;39:S1S34.
12. Marschall, J, Mermel, LA, Fakih, M, et al. Strategies to prevent central line–associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:753771.
13. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter‐related BSIs in the ICU. N Engl J Med 2006;355:27252732.
14. Dudek, MA, Weiner, LM, Allen-Bridson, K, et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Control 2013;41:11481166.
15. Tancrede, CH, Andremont, AO. Bacterial translocation and gram-negative bacteremia in patients with hematological malignancies. J Infect Dis 1985;152:99103.
16. See, I, Iwamoto, M, Allen-Bridson, K, Horan, T, Magill, SS, Thompson, ND. Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition. Infect Control Hosp Epidemiol 2013;34:769776.
17. Centers for Disease Control and Prevention. Central line–associated bloodstream infection (CLABSI) event. Available at: Accessed October 2, 2013.
18. Lalla, RV, Bowen, J, Barasch, A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014;120:14531461.
19. Gibson, RJ, Keefe, DM, Lalla, RV, et al. Systematic review of agents for the management of gastrointestinal mucositis in cancer patients. Support Care Cancer 2013;21:313326.


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