Changing Rate of Bloodstream Infection Across Duration of Central Venous Access
Background: Patients with central lines (CL) have increased rates of blood-stream infection during hospitalization. While rates of central line-associated bloodstream infection (CLA-BSI) are widely reported in the literature, most studies assume a constant infection rate throughout duration of CL use.
Objective: Our objective was to determine whether CLA-BSI rate varied over CL duration adjusting for changes in risk factor distribution throughout that time.
Methods: We included 27,397 patients with CLs from a tertiary academic medical center between 2002-2007. Data were collected from electronic health records. We used discrete-time hazards to model CLA-BSI across CL duration and obtained adjusted odds ratios (OR) for effect of gender, race, age, patient location, hospital service, and comorbidities on CLA-BSI rate.
Results: Patients developed 1380 CLA-BSI in 409,458 CL-days. CLA-BSI increased through the first two weeks of CL duration from 1.60 per 1000 CL-days (95% confidence interval (CI) 1.39, 1.80) on days 1-3 to 5.07 (95%CI 3.99, 6.16) per 1000 CL-days on days 16-18 (see figure). After dropping to 4.12 (95%CI 3.21, 5.03) per 1000 CL-days to end week three, CLA-BSI increased with subsequent duration. Risk of CLA-BSI was higher in Black individuals (OR 1.36, 95% CI 1.21, 1.54), and those in intensive care units (OR 1.34, 95% CI 1.19, 1.52) or on a surgical service (OR 1.15, 95% CI 1.00, 1.33). In the first week, males had increased CLA-BSI risk compared to females (OR 1.32, 95% CI 1.13, 1.55).
Conclusions: CLA-BSI rate was not constant across CL duration. Variation remained after adjusting for the changing population at risk. Awareness of patients at increased risk, monitoring throughout hospitalization and timing interventions and surveillance appropriately could reduce the incidence of CLA-BSI.
Figure. Rate of central line associated blood-stream infections over time for men and women (with 95% confidence intervals). Solid line represents men; dotted line represents women.