The CONSIDER study: assessing the risk of catheter-associated bloodstream infections beyond the intensive care setting.

Abstract

Background: Catheter-associated and related bloodstream infection (CABSI and CRBSI) are major causes of hospital- acquired infections. However, their incidence and risk factors in non-ICU patients with vascular access devices (VADs) are scarce.

Methods: This retrospective study conducted at a large university Hospital of Northern Italy (2021-2024) evaluated CABSI and CRBSI incidence and risk factors in non-ICU hospitalized adults with VADs. Hazard ratios (HR) were estimated with gamma frailty models and random survival forest analysis with sensitivity tests. Key variables were identified and validated in multivariable models.

Results: Among 2,326 VAD insertions (corresponding to 1,892 patients), 153 with CRBSI or CABSI were identified. The incidence was 1.80 per 1,000 catheter-days for CABSI, 1.24 per 1,000 catheter-days for CRBSI, and the overall incidence of around 2.97 per 1,000 catheter-days. Coagulase-negative staphylococci were the most isolated pathogens (43.9%). Infections were associated to factors such as parenteral nutrition (PN) (HR = 4.12) and multi-lumen catheters (HR = 2.56). Random Survival Forest models identified PN, intravenous drug use (IVDU), and in-patient regimen as top variables. Specifically, CRBSI showed stronger associations with PN (HR = 7.42), while CABSI was linked to IVDU (HR = 7.20).

Conclusion: Our study showed a significantly high incidence of CABSI and CRBSI in non-ICU adult patients. By identifying the risk factors of these infections, it suggests the settings in which stringent infection prevention strategies are needed.