Risk factors for catheter-related bloodstream infections in adult hospitalized patients — multicenter cohort study

Abstract

Background: Risk factors for catheter-related bloodstream infections (CRBSIs) may change over time with progress in infection control. This study was undertaken to explore the current risk factors for CRBSIs in hospitalized patients. Methods: Adult patients with non-tunneled central venous catheters (CVCs) in 12 Japanese referral hospitals were prospectively enrolled between December 2009 and January 2012. Patients were monitored for CRBSIs for up to 8 weeks from CVC insertion; data were collected regarding patient characteristics, the purpose of CVC insertion, insertion methods, mechanical complications during insertion, and post-insertion catheter care. Results: A total of 892 patients were enrolled in this study. The overall incidence of CRBSIs was 0.40 infections per 1000 catheter-days. Univariate analysis using the Fisher's exact test identified one of the participating hospitals (hospital A; p < 0.001), internal jugular vein catheterization (IJVC) (p = 0.0013), not using maximal sterile barrier precautions (p = 0.030), and the Seldinger technique for catheter insertion (p = 0.025) as significant risk factors for CRBSI. After excluding data from hospital A, only IJVC remained a significant risk factor for CRBSI (p = 0.025). The cumulative probability of remaining without CRBSI was significantly lower in patients with IJVCs than in patients with other catheter routes (p < 0.001; log-rank test). Similarly, the cumulative probability of remaining without catheter removal due to a suspected infection was significantly lower in patients with IJVCs (p = 0.034; log-rank test). Conclusions: The current study suggests that IJVC might be a risk factor for CRBSI under current infection control conditions.

Keywords::

• Catheter-related infection
• risk factor
• internal jugular vein

Acknowledgements

The authors wish to thank all of the following institutional investigators for collecting the patient data: Masaharu Odo, NHO Kumamoto Medical Center; Kazunori Takeda, NHO Sendai Medical Center; Osamu Kimura, NHO Yonago Medical Center; Kiyoto Takehara, NHO Iwakuni Clinical Center; Nobuo Tsutsumi, NHO Kokura Medical Center; Hitoshi Ueda, NHO Fukuoka Hospital.

Declaration of interest: This work was supported by a grant for NHO network clinical research. The authors declare no conflicts of interest.