Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India

Mishra, Shakti Bedanta; Misra, Richa; Azim, Afzal; Baronia, Arvind Kumar; Prasad, Krishna; Dhole, T.N.; Gurjar, Mohan; Singh, Rajni; Poddar, Banani

doi:10.1093/intqhc/mzw144

Cited by 20 publications

(45 citation statements)

References 29 publications

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“…(3-7) In the adult population, factors associated with CLABSIs include the site of CVC insertion and the duration of CVC use, the presence or absence of underlying disease, the severity score, the presence or absence of immunosuppression, the type of dressing used and whether an aseptic insertion technique is used. (8-11) However, information on factors associated with CLABSI in the pediatric population is limited, especially in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units

Torre¹,

Baldanzi²,

Troster³

2018

Revista Brasileira De Terapia Intensiva

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ObjectivesTo determine the risk factors for acquiring central line-associated blood stream infections (CLABSI) in pediatric intensive care units and to investigate the incidence and etiology of CLABSI in pediatric intensive care units with different profiles.MethodsThe study was a prospective cohort study in three hospitals. One of the hospitals is a large metropolitan public hospital with two pediatric intensive care units and a total of nineteen pediatric intensive care unit beds, another is a regional hospital with eight pediatric intensive care unit beds, and the third is a private hospital with fifteen beds. Patients between the ages of 1 month old and 18 years old who used a central venous catheter for over 24 hours were included. We recorded patients’ daily progress. General patient and catheter-related data were collected and used as variables. All the data were analyzed using Statistical Package for Social Science (SPSS), version 13.0, to compare patients with CLABSI with or without risk factors.ResultsA total of 728 patients were admitted to the pediatric intensive care units, and 170 had a central line in place for at least 24 hours. The median age was 32 months, and 97 (57%) of the patients were males. The CLABSI incidence rate was 3.9/1000 central venous catheter-days. The incidence among hospitals varied from 1.6 to 6.6. The overall mortality rate was 11.1%, and the CLABSI and non-CLABSI mortality rates were 12.9% and 10.7%, respectively. In multivariate analysis, independent risk factors for CLABSI were a longer duration of central venous catheter use (OR: 1.07; 95%CI 1.00 - 1.14; p = 0.019) and the use of more than one central venous catheter at once (OR: 2.59; 95%CI 1.17 - 5.73; p = 0.048).ConclusionA longer duration of central venous catheter use and the use of more than one central venous catheter at once were the main risk factors for CLABSI in pediatric intensive care units.

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Section: Introductionmentioning

confidence: 99%

Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units

Torre¹,

Baldanzi²,

Troster³

2018

Revista Brasileira De Terapia Intensiva

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“…First, this was a single-center, retrospective study that was subject to potential unmeasured confounding factors. Nevertheless, to date, it includes the largest cohort of patients with CVCs and suspected CRBSIs, and it includes more established prognostic factors than previous studies [ 11 , 25 ], as well as known sensitive indicators for the development of CRBSI [ 13 ]. Second, in this cohort, it was difficult to distinguish between delayed and prompt removal [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Attributable Mortality of Catheter-Related Bloodstream Infections in the Intensive Care Unit After Suspected Catheters Infection: A Retrospective 10-year Cohort Study

et al. 2021

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Introduction Catheter management strategies for suspected catheter-related bloodstream infection (CRBSI) remain a major challenge in intensive care units (ICUs). The objective of this study was to determine the incidence, risk factors, and mortality attributable to CRBSIs in those patients. Methods A population-based surveillance on suspected CRBSI was conducted from 2009 to 2018 in a tertiary care hospital in China. We used the results of catheter tip culture to identify patients with suspected CRBSIs. Demographics, systemic inflammatory response syndrome (SIRS) criteria, interventions, and microorganism culture results were analysed and compared between patients with and without confirmed CRBSIs. Univariate and multivariate analyses identified the risk factors for CRBSIs, and attributable mortality was evaluated with a time-varying Cox proportional hazard model. Results In total, 686 patients with 795 episodes of suspected CRBSIs were included; 19.2% (153/795) episodes were confirmed as CRBSIs, and 17.4% (119/686) patients died within 30 days. The multifactor model shows that CRBSIs were associated with fever, hypotension, acute respiratory distress syndrome, hyperglycaemia and the use of continuous renal replacement therapy. The AUC was 77.0% (95% CI 73.3%–80.7%). The population attributable mortality fraction of CRBSI in patients was 18.2%, and mortality rate did not differ significantly between patients with and without CRBSIs (95% CI 0.464–1.279, P = 0.312). Conclusions This initial model based on the SIRS criteria is relatively better at identifying patients with CRBSI but only in domains of the sensitivity. There were no significant differences in attributable mortality due to CRBSI and other causes in patients with suspected CRBSI, which prompt catheter removal and re-insertion of new catheter may not benefit patients with suspected CRBSIs. Trial Registration China Clinical Trials Registration number; ChiCTR1900022175. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00429-3.

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“…A recent Brazilian study shows that the average length of ICU stay of 38.2 ± 28.8 days before the diagnosis of bloodstream-related infection, higher than that found in the present research9. Another study showed that the length of stay catheter longer than 10 days and in the ICU longer than 21 days are risk factors for central venous catheter-related infection [9][10][11][12] . Thus, the mean length of catheter stay found in the present study is below that reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Studies indicate that the incidence of obstructing thrombus ranges from 3% to 79% in central venous catheters. Signs of obstruction can be observed by stopping the infusion or when the alarm on the infusion pump occurs 10,11 . A Spanish study demonstrates that the occurrence of obstruction is directly related to the number of lumens of the catheter, with an incidence of obstruction of 4.96% [10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

“…Signs of obstruction can be observed by stopping the infusion or when the alarm on the infusion pump occurs 10,11 . A Spanish study demonstrates that the occurrence of obstruction is directly related to the number of lumens of the catheter, with an incidence of obstruction of 4.96% [10][11][12] . In the present study, the incidence of occlusion in a double lumen central venous catheter was six (33.3%) and two triple lumen central venous catheter (16.6%), corroborating with the studies cited in relation to the higher incidence of obstruction or occlusion in triple lumen catheter over double lumen catheter.…”

Section: Discussionmentioning

confidence: 99%

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Cost minimization analysis: use of dual and triple lumen central venous cateter

Costa

Marta

Peregrino

et al. 2020

R.pesq.:cuid.fundam.Online

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Objetivo: analisar o custo da utilização do cateter venoso central de duplo versus triplo lúmen em uma unidade de terapia intensiva. Métodos: estudo de custo-minimização, com abordagem quantitativa à luz da avaliação econômica de saúde. Foram analisados custos e a ocorrência de eventos adversos em uma amostra com 30 cateter venoso central. A coleta de dados foi através de um check list com dados do prontuário. Os dados foram tabulados e analisados a partir da árvore de decisão através do software Tree Age®. Resultados: o cateter venoso central triplo lúmen teve um custo relacionado a eventos adversos de R$7.648,22 apresentando-se superior ao duplo lúmen. Conclusão: a quantidade de lúmens está relacionada a maior ocorrência de eventos adversos e a um maior custo. Dessa forma, contribui com a enfermagem por direcionar a aplicação de recursos financeiros e orientar estratégias para minimizar a ocorrência de eventos adversos.

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Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India

Abstract: Our results underscore the need for strict institutional infection control measures. Regular training module for doctors and nurses for catheter insertion and maintenance with a checklist on nurses' chart for site inspection and alerts in all shifts are some measures planned at our center.

Cited by 20 publications

References 29 publications

Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units

Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units

Incidence, Risk Factors, and Attributable Mortality of Catheter-Related Bloodstream Infections in the Intensive Care Unit After Suspected Catheters Infection: A Retrospective 10-year Cohort Study

Cost minimization analysis: use of dual and triple lumen central venous cateter

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