Incidence, Risk Factors, and Outcomes of Central Line-Associated Bloodstream Infections in Trauma Patients

Negaar Aryan; Areg Grigorian; James Jeng; Catherine Kuza; Allen Kong; Lourdes Swentek; Sigrid Burruss; Jeffry Nahmias

doi:10.1089/sur.2024.040

Incidence, Risk Factors, and Outcomes of Central Line-Associated Bloodstream Infections in Trauma Patients

Surg Infect (Larchmt). 2024 May 16. doi: 10.1089/sur.2024.040. Online ahead of print.

Authors

Negaar Aryan¹, Areg Grigorian¹, James Jeng¹, Catherine Kuza², Allen Kong¹, Lourdes Swentek¹, Sigrid Burruss¹, Jeffry Nahmias¹

Affiliations

¹ Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA.
² Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA.

PMID: 38752327
DOI: 10.1089/sur.2024.040

Abstract

Introduction: Central line-associated blood stream infection (CLABSI) is a hospital-acquired infection (HAI) associated with increased morbidity and mortality among the general patient population. However, few studies have evaluated the incidence, outcomes, and risk factors for CLABSI in trauma patients. This study aimed to identify the rate of positive (+)CLABSI in trauma patients and risk factors associated with (+)CLABSI. Methods: The 2017-2021 Trauma Quality Improvement Program database was queried for trauma patients aged ≥18 years undergoing central-line placement. We compared patients with (+)CLABSI vs. (-)CLABSI patients. Bivariate and multivariable logistic regression analyses were performed. Results: From 175,538 patients undergoing central-line placement, 469 (<0.1%) developed CLABSI. The (+)CLABSI patients had higher rates of cirrhosis (3.9% vs. 2.0%, p = 0.003) and chronic kidney disease (CKD) (4.3% vs. 2.6%, p = 0.02). The (+)CLABSI group had increased injury severity score (median: 25 vs. 13, p < 0.001), length of stay (LOS) (median 33.5 vs. 8 days, p < 0.001), intensive care unit LOS (median 21 vs. 6 days, p < 0.001), and mortality (23.7% vs. 19.6%, p = 0.03). Independent associated risk factors for (+)CLABSI included catheter-associated urinary tract infection (CAUTI) (odds ratio [OR] = 5.52, confidence interval [CI] = 3.81-8.01), ventilator-associated pneumonia (VAP) (OR = 4.43, CI = 3.42-5.75), surgical site infection (SSI) (OR = 3.66, CI = 2.55-5.25), small intestine injury (OR = 1.91, CI = 1.29-2.84), CKD (OR = 2.08, CI = 1.25-3.47), and cirrhosis (OR = 1.81, CI = 1.08-3.02) (all p < 0.05). Conclusion: Although CLABSI occurs in <0.1% of trauma patients with central-lines, it significantly impacts LOS and morbidity/mortality. The strongest associated risk factors for (+)CLABSI included HAIs (CAUTI/VAP/SSI), specific injuries (small intestine), and comorbidities. Providers should be aware of these risk factors with efforts made to prevent CLABSI in these patients.

Keywords: central line-associated bloodstream infections (CLABSI); central-line; hospital-acquired infection.