Current Status And Disease Burden Of Central Line-associated Bloodstream Infection(CLABSI)of Adult Patients In ICU Of A Tertiary Hospital

ObjectiveCentral Line-associated Bloodstream Infection(CLABSI)is a common type of nosocomial infection,and associated with poor prognosis and high costs.About 80%of primary bacteremia is associated with the placement of central catheters in modern medicine.At present,China is mainly inclined to the screening of risk factors ofCLABSI,pathogenic bacteria,targeted monitoring,cluster intervention or care,and there is little literature about the economic burden of CLABSI.and accurate estimation of its disease burden results is rare.In this study,we tried to understand the infection status of CLABSI,including the incidence,pathogen species and drug resistance of main pathogens,and using appropriate statistical analysis to obtain the unbiased estimates of mortality,extended hospital stay,and increased medical costs as well as the indirect economic burden.So as to attract the attention of health administrative departments,medical insurance management departments,hospital managers and medical workers to hospital infection control,and provide the basis for guiding clinical rational application of antimicrobial agents,formulating cost control measures and medical resource redistribution policies.MethodsWe take on January 1,2015 to December 31,2017,our countiry some hospital ICU patients with indwelling central vascular catheter of adult as the research object.Case data,such as medical record ID,name,gender,age,main diagnosis,time of admission,time of catheterization,time of infection,time of extubation,time of discharge,occurrence of central vascular catheter bloodstream infection,surgery,catheterization site,ICU category,pathogenic bacteria,drug sensitivity test results,were collected by RT-NISS.However,the Hospital Information System(HIS)was used to collect the data of total hospital expenses,various types of expenses and payment methods.We conducted 1:1 case-control matching according to the incidence density sampling method to alleviate the time-dependent bias.Then,we used appropriate statistical analysis methods such as stratified analysis and multiple linear regression,to adjust for confounding factors,such as patients'basic characteristics,major diagnostic diseases and interference of payment methods,so as to obtain unbiased estimates of CLABSI's mortality,extended hospital stay and increased hospital costs.We also estimated the indirect financial burden of CLABSI based on extended hospital stays.Results1.Major pathogenic bacteria and their drug resistanceA total of 168 strains of pathogenic bacteria were detected in 106 CLABSI patients,among which 68(40.48%)Gram-negative bacteria(G-),56(33.33%)Gram-positive bacteria(G+)and 44(26.19%)fungi were detected.The first two kind of G-were Klebsiella pneumoniae and Acinetobacter baumannii.Staphylococcus epidermidis and Enterococcus faecalis were the first two kind of G+,and the first two kind of fungi were Candida albicans and Near-smooth Candida.Klebsiella pneumoniae has a drug resistance rate of over 90%to ampicillin,over 80%to eight antibacterial drugs such as ertapenem and furantoin,over 70%to imipenem,piperacillin,tazobactam and cefepime,and over 50%to compound sulfamethoxazole and gentamicin.However,no strain resistant to tegacycline was found.The drug resistance rate of Acinetobacter baumannii to ceftazidime,cefepime,ceftriaxone and ciprofloxacin exceeded 80%,among which the drug resistance rate to ciprofloxacin was over 85%.The drug resistance rate to imipenem,gentamicin,ofloxacin and ampicillin was over 70%,and the drug resistance rate to piperacillin was over 60%.For furantoin,cefazolin,ceftitan,tobramycin,tegacycline,amitracillin,ampicillin 100%intermediation.The drug resistance rate of Enterococcus faecium to ofloxacin,ampicillin,ciprofloxacin and penicillin exceeded 85%,and that to furantoin and tetracycline exceeded 70%.No strain was found to be resistant to clindamycin,linezolid,tegacycline and moxifloxacin.The drug resistance rate of Staphylococcus epidermidis to erythromycin and penicillin was 100%.Its drug resistance rate to benzocillin exceeded 80%,and to clindamycin and ofloxacin exceeded 60%.No strain was found to be resistant to vancomycin,linezolid,furantoin and tegacycline.2.Incidence of CLABSIFrom January 1,2015 to December 31,2017,a total of 8,362 adults in the ICU were indwelling central vascular catheters,generating 99802 catheter use days.There were 106 new infections and the number of new infections was 106,so the incidence was 1.062 per 1000 catheter use days.The monthly incidence ranged fr-om 0.388-1.596 per 1000 catheters,with the highest incidence of CLABSI in December and January.3.Mortality of CLABSIA total of 81 cases and controls were included in the mortality study of CLABSI.The mortality of CLABSI patients was 12.3%,but there was no significant difference from that of non-CLABSI patients(8.6%).After stratified analysis,it was found that the mortality of CLABSI patients was 29.4%,higher than that of non-CLABSI patients(0.0%)(P=0.002).4.Extended hospital stay and increased financial burden due to CLABSIA total of 70 cases and controls were used to analyze the extended hospital stay and increased financial burden due to CLABSI.After adjusting for confounding factors,such as age(continuous variables),gender(male/female),major diagnosis(neurological disease/respiratory diseases,etc.),discharge way(normal/death),payment method(full fee/off-site medical insurance/military reform,etc.),site of a central catheter(intracervical vein/subclavian vein/femoral vein/PICC),whether surgery(yes/no),ICU category(neural medicine intensive care unit/extracardiac care unit,etc.),we found that compared with NON-CLABSI patients,CLABSI patients,the hospitalization days were extended by 12.7 days(P=0.04),and the total hospitalization expenses increased by 231775.2 yuan(P=0.001).The main increased cost categories from high to low were 13304.6 yuan(P=0.029)for western medicine,51296.2 yuan for treatment(P?0.015),35115.2 yuan for inspection(P<0.001),and 5075.1 yuan for blood transfusion(P=0.011).The special inspection fee was 3825.3 yuan(P=0.002)and the nursing fee was 1828.4 yuan(P=0.029).There was no significant difference between the CLABSI and NON-CLABSI patients in the cost of bed,Chinese medicine,radiation,surgery,diagnosis and other costs(P>0.05).The indirect economic loss caused by CLABSI is 3282.1 yuan,and the total economic burden caused by CLABSI is 235057.3 yuan.Conclusion1.The pathogenic bacteria of CLABSI were mainly gram-negative bacteria,and the proportion of fungi also increased.The drug resistance rate of major pathogenic bacteria is high and increasingly serious.2.The incidence of adult CLABSI:in ICU of this hospital is low and stable.The monthly incidence fluctuated between 0.388-1.596 per 1000 catheter use day,and the three-year average incidence was 1.062 per 1000 catheter use day.3.The mortality rate of adult CLABSI patients in ICU was 12.3%,and CLABSI increases the risk of death in people with circulatory disease.4.Adult ICU patients have extended the hospital stay for 12.7 days and increased the economic loss of at least 235,000 yuan due to CLABSI.