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

Abstract

Background

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

Objective

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

Methods

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.

Results

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).

Conclusions

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.

Keywords

peripheral intravenous catheters vascular access device central venous catheter hospital-onset bacteremia hospital-acquired infection infection prevention

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References

Alexandrou

Ramjan

Spencer

, et al. (2011) The use of midline catheters in the adult acute care setting – clinical implications and recommendations for practice. Journal of the Association for Vascular Access 16(1): 35–41, No longer published by Elsevier.

Alexandrou

Ray-Barruel

Carr

, et al. (2015) International prevalence of the use of peripheral intravenous catheters. Journal of Hospital Medicine 10(8): 530–533.

Alexandrou

Ray-Barruel

Carr

, et al. (2018) Use of short peripheral intravenous catheters: characteristics, management, and outcomes worldwide. Journal of Hospital Medicine 13(5): 1–7.

Anesthesiology (2020) Practice guidelines for central venous access 2020: an updated report by the American society of anesthesiologists task force on central venous access. Anesthesiology 132(1): 8–43.

Blauw

Foxman

, et al. (2019) Risk factors and outcomes associated with hospital-onset peripheral intravenous catheter-associated Staphylococcus aureus bacteremia. Open Forum Infectious Diseases 6(4): ofz111.

Centers for Disease Control and Prevention (2018) Hospital Toolkit for Adult Sepsis Surveillance.

Centers for Disease Control and Prevention (2024) National Healthcare Safety Network Patient Safety Component Manual. Available at: https://www.cdc.gov/nhsn/pdfs/validation/2024/pcsmanual_2024.pdf (accessed 16 January 2025).

Fagan

Edwards

Park

, et al. (2013) Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990-2010. Infection Control & Hospital Epidemiology 34(9): 893–899.

Gandra

Singh

Chakravarthy

, et al. (2024) Epidemiology and preventability of hospital-onset bacteremia and fungemia in 2 hospitals in India. Infection Control & Hospital Epidemiology 45(2): 157–166.

10.

Gidey

Hailu

, et al. (2023) Clinical and economic burden of healthcare-associated infections: a prospective cohort study. PLoS One 18(2): e0282141.

11.

Harrel

JFE

(2015) Regression modeling strategies - with applications to linear models, logistic and ordinal regression, and survival analysis. R Software 70(4): v070b02.

12.

Helm

Klausner

Klemperer

, et al. (2015) Accepted but unacceptable: peripheral IV catheter failure. Journal of Infusion Nursing 38(3): 189–203.

13.

Hospital Acquired Conditions | CMS (nd). Available at: https://www.cms.gov/medicare/quality/value-based-programs/hospital-acquired-conditions (accessed 1 February 2024).

14.

Krishnan

Gettler

Campbell

, et al. (2024) Comparative epidemiology of hospital-onset bloodstream infections (HOBSIs) and central line-associated bloodstream infections (CLABSIs) across a three-hospital health system. Infection Control & Hospital Epidemiology 45(8): 1–7. https://doi.org/10.1017/ICE.2024.38 (1 August 2024).

15.

PSC Data Validation Resources | NHSN | CDC (2020). Available at: https://www.cdc.gov/nhsn/validation/2020.html (accessed 1 February 2024).

16.

Ridgway

Sun

Tabak

, et al. (2016) Performance characteristics and associated outcomes for an automated surveillance tool for bloodstream infection. American Journal of Infection Control 44(5): 567–571.

17.

Rock

Thom

Harris

, et al. (2016) A multicenter longitudinal study of hospital-onset bacteremia: time for a new quality outcome measure?Infection Control and Hospital Epidemiology 37(2): 143–148.

18.

Schrank

Snyder

Leekha

(2023) Hospital-onset bacteremia and fungemia: examining healthcare-associated infections prevention through a wider lens. In: Antimicrobial Stewardship & Healthcare Epidemiology: ASHE 3(1). Cambridge University Press.

19.

Stack

Dbeibo

Fadel

, et al. (2024) Etiology and utility of hospital-onset bacteremia as a safety metric for targeted harm reduction. American Journal of Infection Control 52(2): 195–199.

20.

Stone

(2009) Economic burden of healthcare-associated infections: an American perspective. Expert Review of Pharmacoeconomics & Outcomes Research 9(5): 417–422, NIH Public Access.

21.

Edwards

, et al. (2022) Hospital-onset bacteremia and fungemia: an evaluation of predictors and feasibility of benchmarking comparing two risk-adjusted models among 267 hospitals. Infection Control & Hospital Epidemiology 43(10): 1317–1325 Cambridge University Press.

22.

Jung

(2023) Characteristics, costs, and outcomes associated with central-line-associated bloodstream infection and hospital-onset bacteremia and fungemia in US hospitals. Infection Control & Hospital Epidemiology 44(12): 1920–1926.