Vascular access devices and hospital-onset bacteremia beyond CLABSI: An observational cohort study

Hospital-onset bacteremia (HOB) has emerged as a broader measure of bloodstream infections beyond CLABSI, capturing infections from all vascular access devices (VADs).

To evaluate the relationship between VADs and HOB in hospitalized adults.

We conducted a retrospective observational study of adult patients hospitalized within a 14-hospital system from January 1, 2022, to December 31, 2023. Adult patients with a VAD and blood cultures collected ≥48 hours after admission were included. HOB was defined as a positive blood culture with a non-commensal organism obtained ≥48 hours after admission and initiation of new antimicrobials within ±2 days of the blood culture date. Logistic regression models evaluated associations between VAD type, quantity, and HOB. Multivariable models controlled for age, length of stay, sex, and comorbid cancer.

Among 3929 hospitalized adults, 279 (7.1%) developed HOB. Patients with HOB had a higher median number of VADs (5 vs 4, p < .001) and more frequently had central (54.5% vs 39.4%, p < .001) and arterial lines (10.9% vs 5.3%, p = .008). Central lines were associated with higher odds of HOB (aOR: 1.48, 95% CI: 1.15-1.91, p = .003), as were arterial lines (aOR: 1.45, 95% CI: 1.11-1.90, p = .008). Each additional VAD increased odds of HOB (aOR: 1.09, 95% CI: 1.01-1.18, p = .028). HOB was associated with higher in-hospital mortality (27.2% vs 16.0%, p < .001) with an adjusted OR of 1.81 (95% CI: 1.36-2.40, p < .001).

The type and number of VADs, particularly central and arterial lines, are associated with increased odds of HOB and higher in-hospital mortality. Infection prevention strategies should focus on minimizing unnecessary VADs and closely monitoring high-risk patients.