Septicemia acquired at the hospital are frequent, serious and potentially preventable, in particular for the septicemia associated to invasive devices. For this reason, Belgium organized a national septicemia surveillance (SEP) since 1992.
The number of hospitals participating for a required minimum of 3 months per year to the SEP surveillance is variable over the period 2000-2011 with annually about 70 to 80 participating hospitals. In the transition year 2011 (review of the protocol), a decrease in the number of participating hospitals (52) was observed. During this period, a total of 49.286 SEP episodes acquired at the hospital was registered, with an incidence of 6,5 SEP/1.000 admissions and 8,4/10.000 patient-days (pd).
The incidence of SEP acquired at the intensive care unit (ICU) was 19,1 SEP/1.000 ICU admissions and 44,5/10.000 pd at ICU. The variability in the number of participating hospitals over the observation period makes the interpretation of the annual trends at the national level difficult.
From these 49.286 episodes, 12.697 (26%) were admitted in an internal medicine service and 10.226 (21%) at ICU. A central venous catheter (CVC) was considered as the origin of infection in 11.665 SEP (25%) (31% of SEP at ICU). However, the fact that a high number of data is missing suggests that the real proportion of CVC associated septicemia may even be higher. A total of 41.936 (41%) of hospital acquired SEP have been documented as being secondary to an infection at another site; from these 6.601 (14%) were attributed to an urinary tract infection and 4.656 (10%) to a pulmonary infection (respectively 6% and 20% at ICU).
Pathogene microorganisms were involved in 41.936 (85%) of hospital acquired SEP. The remaining 7.350 (15%) were caused exclusively by skincontaminants. The most common microorganisms were E. coli (17%), S. aureus (12%) and types of Staphylococcus coagulase-negative (11%). The specific incidence of hospital acquired SEP with E. coli increased from 1,2/10.000 pd in 2000 to 1,7/10.000 pd in 2011. The specific incidence of hospital acquired SEP caused by Pseudomonas aeruginosae and Klebsiella pneumoniae remained stable.
These incidence data are higher than those reported by the surveillances (hospitalwide) from other countries. The results highlight the importance of the strengthening of the precautions against hospital acquired SEP and in particular SEP associated with invasive devices and SEP acquired at ICU.