PURPOSE: To identify risk factors associated with the development of CLABSI in a MICU.
METHODS: Single center, retrospective study performed between January and December 2010. Critically ill patients who developed CLABSI according to the Centers of Disease Control (CDC) definitions were analyzed and compared to a group of matched controls.
RESULTS: Eighty patients were included in the study; forty in the CLABSI group were compared to forty matched controls. Apache IV scores were similar between groups (85.1 ± 32 in the CLABSI group vs. 89.0 ± 34 among controls, p = 0.61). Fifty nine central venous catheters were implicated in 41 documented CLABSI, accounting for 1 CLABSI every 246.3 line-days. Mean time from the time of central venous catheter insertion to infection was 10.5 ± 6 days. Patients in the CLABSI group were exposed to 22.0 ± 17.4 catheter/days vs. 11.6 ± 10.5 among controls (p=0.001). A second central venous catheter was present in 18/41 (43.9%) CLABSI episodes. There were 45 identified pathogens associated with these infections, four events were polimicrobial. Gram-positive organisms were isolated in 22/45 (48.9%) cultures, gram-negatives in 11/45 (24.4%), and fungi in 12/45 (26.7%). The three most common CLABSI causative organisms were: Vancomycin-resistant enterococcus in 14/45(31.1%), Pseudomonas aeruginosa in 6/45 (13.3%), and Candida albicans in 6/45 (13.3%) cultures. Resistant organisms were identified in 29/45 (64.4%) cultures. At the time of diagnosis, 30/40 (75%) patients in the CLABSI group were receiving steroids vs. 21/40 (52.5%) in the control group (p=0.06). Mean ICU length of stay (LOS) was 20.2 ± 14 days in the CLABSI group vs. 9.7 ± 7 days among controls (p=<0.001). There was a trend towards increased mortality in the CLABSI Group (62.5% vs. 52.5%, p=0.37).
CONCLUSIONS: Central line-associated bloodstream infections occur more frequently in patients with multiple short term vascular catheters in place simultaneously for a prolonged time (>7 days) and may be associated with higher ICU mortality. Multi drug resistant organisms are frequent pathogens. The use of steroids may be associated with increased risk for CLABSI development.
CLINICAL IMPLICATIONS: In spite of line bundle implementation, CLABSI occurs and presents a clinical challenge. Multidrug resistant organisms rather than skin pathogens should be targeted when treating CLABSI. Line maintenance and clinical factors such as steroid use may be related to CLABSI development.
DISCLOSURE: The following authors have nothing to disclose: Gustavo Cumbo-Nacheli, Hugo Paz y Mar, Sara Cobb, Jorgelina de Sanctis, Jorge Guzman
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