Central line + positive blood culture = CLABSI (not!)

There's a thoughtful commentary in a recent issue of Clinical Infectious Diseases by Tom Fraser and Steve Gordon at Cleveland Clinic on problems related to CDC's central line associated bloodstream infection (CLABSI) case definition. We've blogged about this before. The definition is old and was designed to maximize sensitivity long before anyone thought about public reporting. But the issues of poor specificity of this definition are haunting many of us, particularly those who work at hospitals with cancer centers. Unfortunately, neutropenic cancer patients not uncommonly have translocation of enteric flora across their intestinal mucosa and the resulting bloodstream infection in the presence of a central line forces us to label these as CLABSIs, even though these infections are not at all related to the central line. Ten years ago no one cared about this surveillance technicality. Now, in the era of public reporting this is a big problem. In fact, nearly every "CLABSI" in the medical ICU of my hospital falls into this category. Fraser and Gordon show us how this is handled at their hospital with a modification to the CDC definition that is used for internal purposes. Hopefully relief is on the way. CDC is very interested in this issue and has assembled a committee that is actively evaluating the issue.