Surveillance Open Access
Like 0



Catheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death.


To analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat).


A cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007–2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000 patient days. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000 patient days and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported.


During the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate: 0.20 episodes/1,000 patient days). Patients’ median age was 64.1 years; 36.6% (3,403/9,290) were female. In total, 73.7% (n = 6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n = 5,822) were related to central venous catheter (CVC), 24.1% (n = 2,236) to peripheral venous catheters (PVC) and 13.3% (n = 1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR: 0.94; 95%CI: 0.93–0.96), especially in the ICU (IRR: 0.88; 95%CI: 0.87–0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR: 0.88; 95%CI: 0.87–0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC: 1.08; 95%CI: 1.05–1.11; IRR PVC: 1.03; 95% 1.00-1.05).


Over the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards.


Article metrics loading...

Loading full text...

Full text loading...



  1. Zarb P, Coignard B, Griskeviciene J, Muller A, Vankerckhoven V, Weist K, et al. . The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill. 2012;17(46):20316.  https://doi.org/10.2807/ese.17.46.20316-en  PMID: 23171822 
  2. Sociedad Española de Medicina Preventiva. Estudio EPINE-EPPS no 30: 2019. Estud EPiNE. 2019;
  3. Zingg W, Metsini A, Balmelli C, Neofytos D, Behnke M, Gardiol C, et al. . National point prevalence survey on healthcare-associated infections in acute care hospitals, Switzerland, 2017. Euro Surveill. 2019;24(32).  https://doi.org/10.2807/1560-7917.ES.2019.24.32.1800603  PMID: 31411135 
  4. Rodríguez-Baño J, López-Prieto MD, Portillo MM, Retamar P, Natera C, Nuño E, et al. . Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect. 2010;16(9):1408-13.  https://doi.org/10.1111/j.1469-0691.2010.03089.x  PMID: 19845694 
  5. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159-71.  https://doi.org/10.4065/81.9.1159  PMID: 16970212 
  6. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309-17.  https://doi.org/10.1086/421946  PMID: 15306996 
  7. Stevens V, Geiger K, Concannon C, Nelson RE, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect. 2014;20(5):O318-24.  https://doi.org/10.1111/1469-0691.12407  PMID: 24112305 
  8. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-32.  https://doi.org/10.1056/NEJMoa061115  PMID: 17192537 
  9. VinCat. Barcelona: Catalan Health Service. [Accessed: 19 Apr 2022]. Available from. https://catsalut.gencat.cat/ca/proveidors-professionals/vincat/index.html#googtrans(ca%7Cen)
  10. Nosocomial Infection Surveillance Programme at Catalan Hospitals (VINCat). 2015 Manual. 2015 Available from: https://catsalut.gencat.cat/web/.content/minisite/vincat/documents/manuals/Manual-VINCat-2015-english.pdf
  11. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Protocol version 5.3. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/PPS-HAI-antimicrobial-use-EU-acute-care-hospitals-V5-3.pdf
  12. Trinh TT, Chan PA, Edwards O, Hollenbeck B, Huang B, Burdick N, et al. Peripheral venous catheter-related Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 2011;32(6):579-83.  https://doi.org/10.1086/660099  PMID: 21558770 
  13. R Core Team. (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria
  14. Almirante B, Limón E, Freixas N, Gudiol F, VINCat Program. Laboratory-based surveillance of hospital-acquired catheter-related bloodstream infections in Catalonia. Results of the VINCat Program (2007-2010). Enferm Infecc Microbiol Clin. 2012;30(Suppl 3):13-9.  https://doi.org/10.1016/S0213-005X(12)70091-5  PMID: 22776149 
  15. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121(2):182-205.  https://doi.org/10.1093/oxfordjournals.aje.a113990  PMID: 4014115 
  16. Palomar M, Álvarez-Lerma F, Riera A, Díaz MT, Torres F, Agra Y, et al. , Bacteremia Zero Working Group. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Crit Care Med. 2013;41(10):2364-72.  https://doi.org/10.1097/CCM.0b013e3182923622  PMID: 23939352 
  17. Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis. 2014;59(1):96-105.  https://doi.org/10.1093/cid/ciu239  PMID: 24723276 
  18. Freixas N, Bella F, Limón E, Pujol M, Almirante B, Gudiol F. Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study. Clin Microbiol Infect. 2013;19(9):838-44.  https://doi.org/10.1111/1469-0691.12049  PMID: 23130638 
  19. Marschall J, Leone C, Jones M, Nihill D, Fraser VJ, Warren DK. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol. 2007;28(8):905-9.  https://doi.org/10.1086/519206  PMID: 17620235 
  20. Zingg W, Sax H, Inan C, Cartier V, Diby M, Clergue F, et al. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect. 2009;73(1):41-6.  https://doi.org/10.1016/j.jhin.2009.05.015  PMID: 19646788 
  21. Tedja R, Gordon SM, Fatica C, Fraser TG. The descriptive epidemiology of central line-associated bloodstream infection among patients in non-intensive care unit settings. Infect Control Hosp Epidemiol. 2014;35(2):164-8.  https://doi.org/10.1086/674856  PMID: 24442079 
  22. Mermel LA. Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review. Clin Infect Dis. 2017;65(10):1757-62.  https://doi.org/10.1093/cid/cix562  PMID: 29020252 
  23. Pujol M, Hornero A, Saballs M, Argerich MJ, Verdaguer R, Cisnal M, et al. Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital. J Hosp Infect. 2007;67(1):22-9.  https://doi.org/10.1016/j.jhin.2007.06.017  PMID: 17719678 
  24. Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín-Rabadán P, et al. , NUVE Study Group. Nationwide study on peripheral-venous-catheter-associated-bloodstream infections in internal medicine departments. J Hosp Infect. 2017;97(3):260-6.  https://doi.org/10.1016/j.jhin.2017.07.008  PMID: 28716670 
  25. Ripa M, Morata L, Rodríguez-Núñez O, Cardozo C, Puerta-Alcalde P, Hernández-Meneses M, et al. Short-term peripheral venous catheter-related bloodstream infections: Evidence for increasing prevalence of Gram-negative microorganisms from a 25-year prospective observational study. Antimicrob Agents Chemother. 2018;62(11):e00892-18.  https://doi.org/10.1128/AAC.00892-18  PMID: 30126952 
  26. Saliba P, Hornero A, Cuervo G, Grau I, Jimenez E, Berbel D, et al. Interventions to decrease short-term peripheral venous catheter-related bloodstream infections: impact on incidence and mortality. J Hosp Infect. 2018;100(3):e178-86.  https://doi.org/10.1016/j.jhin.2018.06.010  PMID: 29928942 
  27. Rhodes D, Cheng AC, McLellan S, Guerra P, Karanfilovska D, Aitchison S, et al. Reducing Staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae: successful implementation of a care bundle at a large Australian health service. J Hosp Infect. 2016;94(1):86-91.  https://doi.org/10.1016/j.jhin.2016.05.020  PMID: 27346623 
  28. Garcia-Gasalla M, Arrizabalaga-Asenjo M, Collado-Giner C, Ventayol-Aguiló L, Socias-Mir A, Rodríguez-Rodríguez A, et al. Results of a multi-faceted educational intervention to prevent peripheral venous catheter-associated bloodstream infections. J Hosp Infect. 2019;102(4):449-53.  https://doi.org/10.1016/j.jhin.2019.02.004  PMID: 30771370 
  29. Braun E, Hussein K, Geffen Y, Rabino G, Bar-Lavie Y, Paul M. Predominance of Gram-negative bacilli among patients with catheter-related bloodstream infections. Clin Microbiol Infect. 2014;20(10):O627-9.  https://doi.org/10.1111/1469-0691.12565  PMID: 24461043 
  30. Marcos M, Soriano A, Iñurrieta A, Martínez JA, Romero A, Cobos N, et al. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens. J Antimicrob Chemother. 2011;66(9):2119-25.  https://doi.org/10.1093/jac/dkr231  PMID: 21665905 
  31. Bouza E, Eworo A, Fernández Cruz A, Reigadas E, Rodríguez-Créixems M, Muñoz P. Catheter-related bloodstream infections caused by Gram-negative bacteria. J Hosp Infect. 2013;85(4):316-20.  https://doi.org/10.1016/j.jhin.2013.08.008  PMID: 24183319 
  32. Lorente L, Jiménez A, Santana M, Iribarren JL, Jiménez JJ, Martín MM, et al. Microorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site. Crit Care Med. 2007;35(10):2424-7.  https://doi.org/10.1097/01.CCM.0000284589.63641.B8  PMID: 17717493 
  33. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. , Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39(4) Suppl 1;S1-34.  https://doi.org/10.1016/j.ajic.2011.01.003  PMID: 21511081 
  34. Stuart RL, Cameron DR, Scott C, Kotsanas D, Grayson ML, Korman TM, et al. Peripheral intravenous catheter-associated Staphylococcus aureus bacteraemia: more than 5 years of prospective data from two tertiary health services. Med J Aust. 2013;198(10):551-3.  https://doi.org/10.5694/mja12.11699  PMID: 23725270 

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error