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The CONSIDER study: Assessing the risk of catheter-associated bloodstream infections beyond the intensive care
Fabio Borgonovo1, Marta Colaneri2, Federico Fassio3
1Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
Insights
Catheter-associated and related bloodstream infections (CABSI and CRBSI) are common in non-ICU patients with vascular access devices (VADs). Parenteral nutrition and multilumen catheters increase infection risk, necessitating targeted prevention strategies.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Medical Device Infections
Background:
- Catheter-associated and related bloodstream infections (CABSI/CRBSI) are significant hospital-acquired infections.
- Data on CABSI/CRBSI incidence and risk factors in non-intensive care unit (non-ICU) patients with vascular access devices (VADs) is limited.
Purpose of the Study:
- To determine the incidence of CABSI and CRBSI in non-ICU hospitalized adults with VADs.
- To identify key risk factors associated with these infections in this patient population.
Main Methods:
- Retrospective study of 2,326 VAD insertions in 1,892 non-ICU patients.
- Analysis of CABSI and CRBSI incidence using gamma frailty models and random survival forest.
- Identification and validation of risk factors through multivariable models.
Main Results:
- Overall incidence of CABSI/CRBSI was 2.97 per 1,000 catheter-days; CABSI incidence was 1.80, and CRBSI incidence was 1.24.
- Coagulase-negative Staphylococci were the most common pathogens (43.9%).
- Parenteral nutrition (PN) (HR=4.12) and multilumen catheters (HR=2.56) were significant risk factors. PN (HR=7.42) strongly predicted CRBSI, while intravenous drug use (HR=7.20) predicted CABSI.
Conclusions:
- Non-ICU adult patients with VADs experience a high incidence of CABSI and CRBSI.
- Identifying specific risk factors like PN and intravenous drug use is crucial for implementing targeted infection prevention strategies in non-ICU settings.
Background:
Catheter-associated and related bloodstream infection (CABSI and CRBSI) are major causes of hospital-acquired infections. However, their incidence and risk factors in non-intensive care unit (ICU) patients with vascular access devices (VADs) remain unclear.
Methods:
This retrospective study evaluated CABSI and CRBSI incidence and risk factors in non-ICU hospitalized adults with VADs. Hazard ratios (HR) were estimated with gamma frailty models and random survival forest analysis. Key variables were identified and validated in multivariable models.
Results:
Among 2,326 VAD insertions (1,892 patients), 153 with CRBSI or CABSI were identified. The incidence was 1.80 per 1,000 catheter-days for CABSI, 1.24 for CRBSI, and 2.97 overall. Coagulase-negative Staphylococci were the most isolated pathogens (43.9%). Infections were associated with parenteral nutrition (PN) (HR = 4.12) and multilumen catheters (HR = 2.56). Random survival forest models identified PN, intravenous drug use, and in-patient regimen as top variables. CRBSI was strongly associated with PN (HR = 7.42), while CABSI was linked to intravenous drug use (HR = 7.20).
Conclusions:
Our study showed a high incidence of CABSI and CRBSI in non-ICU adult patients. Identifying risk factors highlights the settings where stringent infection prevention strategies are needed.
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