Risk factors for catheter-related bloodstream infections (CRBSI) in adult hospitalized patients

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Intravenous literature: Haga, Y., Miyanari, N., Takahashi, T., Koike, S., Kobayashi, R., Mizusawa, H., Nakamichi, C. and Goto, M. (2013) Risk factors for catheter-related bloodstream infections in adult hospitalized patients – multicenter cohort study. Scandinavian Journal of Infectious Diseases. July 15th. [Epub ahead of print].

Abstract:

Background: Risk factors for catheter-related bloodstream infections (CRBSIs) may change over time with progress in infection control. This study was undertaken to explore the current risk factors for CRBSIs in hospitalized patients.

Methods: Adult patients with non-tunneled central venous catheters (CVCs) in 12 Japanese referral hospitals were prospectively enrolled between December 2009 and January 2012. Patients were monitored for CRBSIs for up to 8 weeks from CVC insertion; data were collected regarding patient characteristics, the purpose of CVC insertion, insertion methods, mechanical complications during insertion, and post-insertion catheter care.

Results: A total of 892 patients were enrolled in this study. The overall incidence of CRBSIs was 0.40 infections per 1000 catheter-days. Univariate analysis using the Fisher’s exact test identified one of the participating hospitals (hospital A; p < 0.001), internal jugular vein catheterization (IJVC) (p = 0.0013), not using maximal sterile barrier precautions (p = 0.030), and the Seldinger technique for catheter insertion (p = 0.025) as significant risk factors for CRBSI. After excluding data from hospital A, only IJVC remained a significant risk factor for CRBSI (p = 0.025). The cumulative probability of remaining without CRBSI was significantly lower in patients with IJVCs than in patients with other catheter routes (p < 0.001; log-rank test). Similarly, the cumulative probability of remaining without catheter removal due to a suspected infection was significantly lower in patients with IJVCs (p = 0.034; log-rank test).

Conclusions: The current study suggests that IJVC might be a risk factor for CRBSI under current infection control conditions.

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