Catheter Duration Threshold and Risk Factors for Central Line-Associated Bloodstream Infections in a Tertiary ICU...

Background/Objectives: Central line-associated bloodstream infections (CLABSIs) remain a leading healthcare-associated infection in intensive care units (ICUs), yet independent risk factors and evidence-based catheter duration thresholds have not been defined through analytical study designs in settings with endemic multidrug-resistant organisms (MDROs). Methods: A retrospective case-control study was conducted in the ICU of a tertiary teaching university hospital in western Türkiye (January 2019-December 2024). Cases (n = 74) were patients with confirmed CLABSIs per CDC/NHSN criteria; controls (n = 148) were randomly selected central venous catheter (CVC)-bearing patients without CLABSIs. A reduced multivariate logistic regression model (seven variables; events-per-variable ratio 10.6) identified independent risk factors. Results: In multivariate analysis, catheter duration (adjusted OR: 1.19 per day; 95% CI: 1.13-1.24; p < 0.001), renal replacement therapy (aOR: 3.66; 95% CI: 1.68-7.95; p = 0.001), vasopressor support (aOR: 3.04; 95% CI: 1.50-6.17; p = 0.002), APACHE-II score (aOR: 1.07 per point; 95% CI: 1.02-1.11; p = 0.002), lower Glasgow Coma Scale (aOR: 0.86 per point; 95% CI: 0.78-0.94; p = 0.002), mechanical ventilation (aOR: 2.48; 95% CI: 1.24-4.95; p = 0.010), and total parenteral nutrition (aOR: 2.33; 95% CI: 1.12-4.86; p = 0.024) were independently associated with CLABSI. The model demonstrated good discrimination (C-statistic: 0.864) and calibration (Hosmer-Lemeshow p = 0.425). Kaplan-Meier analysis showed CLABSI-free survival declining from 98.9% at day 7 to 42.9% at day 21 (log-rank p < 0.001); these within-study estimates reflect relative risk patterns given the artificial 1:2 case-to-control ratio. Receiver operating characteristic (ROC) analysis identified day 13 as an exploratory optimal cutoff (AUC: 0.818; 95% CI: 0.762-0.874; sensitivity: 77.0%; specificity: 74.3%). CLABSI-attributable ICU mortality was 20.3% (47.3% vs. 27.0%; p = 0.004). Late-onset CLABSIs (>10 days) were dominated by Gram-negative pathogens (68.3%) versus 35.7% in early-onset infections (Fisher's exact p = 0.012), with Acinetobacter baumannii as the predominant organism (27.0%; 83.3% carbapenem-resistant). Conclusions: Each additional catheter-day is independently associated with a 19% increment in CLABSI odds, with an exploratory critical threshold at day 13 beyond which enhanced surveillance measures should be considered, pending external validation.