Predictors of early line removal and successful line retention in potential central line-associated blood stream infections (CLABSIs) in haematology patients: A retrospective cohort study.

Background: Patients with haematologic malignancies are at risk of central line associated bloodstream infections (CLABSI) and their adverse outcomes. Line removal is often considered necessary for cure but creates substantial morbidity, and neutropenic patients often have alternative sources of bloodstream infection (BSI). Patients suitable for a line retention strategy remain ill-defined.

Methods: We conducted a single centre retrospective cohort study of haematology inpatients who developed BSI with a central line in situ. Line retention was defined as line remaining in situ for ≥72 hours post BSI. The primary outcome was failure of line retention, defined as line removal >72 hours post BSI or recurrent BSI with the same organism within 3 months. Predictors of failure of line retention, early line removal (<72 hours) and IDSA central line related BSI (CRBSI) (research-definition CRBSI) were assessed using multivariable analysis.

Results: Of 288 episodes of BSI included between 1/1/2018 and 31/12/2022, 209 cases had retention of line >72 hours and 52 of these (24.9%) experienced failed line retention, with prolonged culture positivity predicting this outcome, and source of BSI other than the line associated with successful line retention on multivariate analysis. 79 (27.4%) had early line removal, with factors associated including intensive care admission, prolonged positive cultures and meeting research-definition CRBSI. Only 27 (9.4%) BSI episodes met the research-definition CRBSI.

Conclusions: Many central lines were removed despite infrequent formal CLABSI diagnoses. Thorough assessments for alternative sources and use of non-invasive diagnostics including repeat blood cultures prior to line removal, may allow increased appropriate retention of lines.