| Background:Central venous catheters(CVCs)are a common treatment option for critically ill patients in the intensive care unit(ICU).Central venous catheters,however,come with significant infection risk.Central-Line Associated Bloodstream Infection(CLABSI),which is increasing in prevalence annually,is a common complication for ICU patients.Therefore as result,we focused on the importance of evaluating the epidemiology of Centralline associated bloodstream infection in ICU patients.Objectives:To analyze the incidence,causative agents and risk factors associated with the development of Central-line associated bloodstream infection in the intensive care unit population over the period of five years.Methods:A retrospective observational study was conducted on patients treated in the ICU of Qilu Hospital of Shandong University between January 2016 and December 2020.The study enrolled patients with at least one central venous catheter(CVC)and recorded relevant information regarding CVC usage.All patients who had catheters placed outside of our hospital,whose peripheral blood or central venous catheter tip cultures were not taken,or whose primary endpoint data were missing were excluded.Acute Physiological and Chronic Health Assessment Ⅱ(APACHEⅡ)scores,Sequential organ failure assessment(SOFA)scores,Charlson Comorbidity Index(CCI)scores,and CVC insertion and removal dates were recorded.The CLABSI incidence was defined as the number of CLABSIs infection in the ICU/number of central line days in the ICU multiplied by 1000 to get the incidence per 1000 catheter days.The diagnosis of Central-line associated bloodstream infection was confirmed if the same microorganism was grown in both a percutaneous blood culture and a catheter tip culture,and the catheter had been in place for more than two days.A linear regression analysis was carried out to analyze the etiology of CLABSI.The measures of association are presented with odds ratios(ORs)and 95%CIs.All tests were two-sided,and p-values<0.05 were considered significant.Statistical analysis was performed in IBM SPSS statistical software version 25.0.We followed the amended Declaration of Helsinki in conducting this study.The protocol used in this study was approved by the Research Ethics Commission of Qilu Hospital of Shandong University.Results:Results 1:Demographic characteristics of patients and Central venous catheters.There were 1920 CVC collected,and 507 were eligible for inclusion.The mean age of the patients in this study was 60.31±16.64,and 355(70%)were male.A total of 101 catheters were inserted at the internal jugular site,113 catheters were inserted at the subclavian site,and 293 catheters were inserted at the femoral venous site.The reasons for CVC placement included infusion of fluids and blood products(20,39.6%),continuous renal replacement therapy(CRRT)(216,42.6%),hemodynamic monitoring(53,10.5%),extracorporeal membrane oxygenation(ECMO)(26,5.1%),parenteral nutrition(1,0.2%),double plasma molecular adsorption system(DPMAS)(1,0.2%)and plasma exchange(8,1.6%).CVCs were removed for suspected CLABSI(172,33.9%),continuous renal replacement therapy discontinuation(38,7.5%),ECMO discontinuation(16,3.2%),catheter thrombosis(12,2.4%),catheter no longer needed(37,7.3%),discharge of the patient(103,20.3%),mechanical complications(15,3.0%),prevention of CLABSI(16,3.2%),death(97,19.1%)or ulceration at the insertion site(1,0.2%).Results 2:Incidence of Cental-LLIne Associated Bloodstream InfectionAmong 507 analyzed catheters,52 had CLABSI episodes and 70 had colonization episodes.The mean duration of catheter placement until the development of infection was 1.60±5.72 in CLABSI cases and 1.88±6.04 in colonization casesOver the period from 2016 to 2020,the annual of CLABSI were 1.91,3.18,1.69,2.97,and 1.27 per 1000 catheter days,respectively.It was observed that CLABSI occurred more frequently at the internal jugular site than at the two other sites,although this difference was not statistically significant.Over the course of five years,the incidence of CLABSI at the three insertion sites was as follows:1.99,4.99,0.99,5.99 and 3.99 infections per 1000 catheter days at the internal jugular site;1.76,2.65,1.76,2.65 and 0.3 infections at the subclavian site;1.94,2.72,1.94.1.94,1.94 and 0.77 infections at the femoral site.There was a longer duration of catheterization in the femoral group(in days)than in the other groups.Results 3:Microbiological patterns associated with Central-Line Associated Bloodstream Infection development:52 cases of CLABSI were caused by 52 microorganisms.Gram-negative bacteria:MDR K.pneumoniae 8(1.6%),MDR Acinetobacter baumanii 8(1.6%),non-MDR K.pneumoniae 0(0.0%),carbapenem resistant Enterobacteriaceae 2(0.4%),Burkholderia cepacia 1(0.2%);Gram-positive bacteria:methicillin-resistant Staphylococcus aureus 11(2.2%),methicillin-sensitive Staphylococcus aureus 1(0.2%),Corynebacterium striata 1(0.2%),Enterococcus faecalis 4(0.8%);yeasts:Candida albicans 16(3.2%).No growth of microorganisms was found in 455(89.7%)samples.Results 4:Risk Factors associated with CLABSI development:By performing multivariate Logistic regression analysis,we found that Age(p=0.004),Charlson comorbidity index(p<0.001)and duration of CVC placement(p=0.001)were associated with an elevated risk of CLABSI.For every 1-year increase in patient age,a 3.3%increase was observed in the odds of developing CLABSI.Each unit increase in the Charlson comorbidity index score was associated with a 3.207-fold higher risk of developing CLABSI.Regarding CVC days,for each 1-day increase in the duration of catheter placement,the risk of developing CLABSI was 1.095 times higher(95%CI)than when the duration decreasedConclusion:Over a 5-year period,we found a mean incidence of CLABSI of 2.2 per 1000 catheter days in intensive care unit patients,with risk factors including age,a Charlson comorbidity index of more than five,and catheter implantation for more more than 8 days.Gram-negative bacteria,Candida albicans,and methicillin-resistant staphylococcus aureus were the major pathogens responsible for the development of CLABSI.After the adoption of infection control,more studies will be required... |
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