VINcat – CRBSI mortality reduction
Abstract:
Background: The incidence of catheter-related bloodstream infections (CRBSI) has fallen over the last decade, especially in intensive care units (ICUs).
Aim: To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality.
Methods: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model.
Findings: Over the study period, 4,795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (HR 0.95 [0.92-0.98]). The multivariate analysis identified age (HR 1.03 [1.02-1.04]), femoral catheter (HR 1.78 [1.33-2.38]), medical ward acquisition (HR 2.07 [1.62-2.65] and ICU acquisition (HR 3.45 [2.7-4.41]), S. aureus (HR 1.59 [1.27-1.99]) and Candida sp. (HR 2.19 [1.64-2.94]) as risk factors for mortality while the mortality rate associated with episodes originating in peripheral catheters was significantly lower (HR 0.69 [0.54-0.88]).
Conclusions: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programs should focus especially on ICUs and medical wards, where incidence and mortality rates are highest.
Reference:
Badia-Cebada L, Peñafiel J, Lopez-Contreras J, Pomar V, Martínez JA, Santana G, Cuquet J, Montero MM, Hidalgo-López C, Andrés M, Gimenez M, Quesada MD, Vaqué M, Iftimie S, Gudiol C, Perez R, Coloma A, Marrón A, Barrufet P, Marimon M, Lérida A, Clarós M, Ramírez-Hidalgo MF, Pardo GG, Martinez MJ, Chamarro EL, Jiménez-Martínez E, Hornero A, Limón E, López M, Calbo E, Pujol M, Gasch O; Surveillance of health-care associated infections in Catalonia (VINCat). Decreased Mortality among Patients with Catheter-Related Bloodstream Infections at Catalan Hospitals (2010-2019). J Hosp Infect. 2022 May 17:S0195-6701(22)00151-7. doi: 10.1016/j.jhin.2022.05.009. Epub ahead of print. PMID: 35594988.