Clinical and economic burden of hospital-wide central line-associated bloodstream infections: a propensity score-matched case-control study
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1Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Department of Infection Control, West China Hospital, Sichuan University, Chengdu, China; Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Background:
Central venous catheters (CVCs) are widely used but carry the risk of central line-associated bloodstream infections (CLABSIs), which threaten patient safety. Although previous CLABSI studies have primarily focused on intensive care units (ICUs), we conducted a hospital-wide prospective investigation using an integrated information system. This study tracked CLABSI outcomes and associated healthcare costs across all patients with CVCs, aiming to evaluate the burden of CLABSI from the patient perspective, with particular attention to differential impacts among patient subgroups.
Methods:
This study used a case-control design. Patients newly diagnosed with CLABSI between January 2023 and June 2024 were enrolled as cases, while contemporaneous catheterised patients without infection were matched 1:1 as controls using propensity score matching. We adjusted for potential confounders, including demographics, comorbidities, and treatment modalities, to assess the impact of CLABSI on length of stay (LOS), in-hospital mortality, and healthcare economic burden. Stratified subgroup analyses were conducted based on the patients' departments.
Findings:
Among 50,862 patients with CVC, the incidence of CLABSI was 0.507 per 1000 catheter-days, predominantly caused by gram-negative bacteria. Propensity-matched analysis (N = 205 pairs) revealed that CLABSI significantly prolonged hospitalisation by 20 days (34 vs 14 days, P < 0.001), increased mortality risk by 88% (22.93% vs 12.20%, P = 0.004), and elevated direct medical costs by $13,962 (P < 0.001). Department-specific analysis demonstrated the greatest economic burden occurred in ICU ($29,211) and internal medicine patients ($10,781), with all differences being statistically significant (P < 0.05).
Conclusion:
CLABSI significantly increased LOS and costs across all departments, highlighting the need for hospital-wide prevention strategies.
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