Infectious Diseases II

IDSA definition: Defines catheter-related bloodstream infection minimally as bacteremia or

fungemia in a patient who has an intravascular device and:

More than 1 positive blood culture obtained from a peripheral vein. A definitive diagnosis

requires that the same organism or organisms grow from at least 1 percutaneous blood culture

and from the CVC tip or that 2 blood cultures, 1 from a catheter hub and 1 from a peripheral

vein, be positive for the same organism(s);

ii.

Clinical manifestations of infection (e.g., fever, chills, and/or hypotension); and

iii.

No apparent source for bloodstream infection other than the catheter.

In 2012, the National Healthcare Safety Network (NHSN) reported central line–associated

bloodstream infection (CLABSI) rates across adult critically ill patient populations of 0.8 to 3.4

episodes per 1000 central line–days. Aggregated national data from 2016 showed almost a 50%

decrease in CLABSI rates from 2008 (0.56-1.00 cases per 1000 central line–days). Although

specific rates vary between sites and populations, all central line types and locations of insertion

have an attributable risk of bloodstream infection.

Accounts for 14,000–28,000 deaths per year

Increases mean LOS by 7 days

population-specific event rates for institution surveillance and performance benchmarks. CMS

no longer provides reimbursement to providers for the treatment of catheter-related bloodstream

infections.

Etiology

CLABSIs are usually monomicrobial. Pathogen prevalence is based on patient-specific risk factors

and underlying illness.

Common organisms responsible for CLABSIs include coagulase-negative staphylococci

(e.g., S epidermidis), S aureus, Candida spp, and enteric gram-negative bacilli (e.g., E coli,

Klebsiella spp, Enterobacter spp).

Risk factors for multidrug-resistant organisms include critical illness, femoral catheter placement,

immunosuppression, and previous antibiotic exposure.

prolonged use of broad-spectrum antibiotics, hematologic malignancy, stem cell or solid-organ

transplantation, femoral catheterization, or colonization owing to Candida spp at several sites.

Risk factors

Patient factors: Diabetes, hypotension, male sex, neutropenia, parenteral nutrition, prolonged

hospitalization before catheter placement

Catheter-related factors: Heavy microbial colonization at insertion site, inadequate catheter care,

internal jugular or femoral vein placement site (compared with subclavian vein), prolonged duration

of venous catheterization, use of non-tunneled catheters

Prevention strategies

Updated recommendations for best practices in the prevention of CLABSI have been sponsored

by SHEA, IDSA, the Association for Professionals in Infection Control, the American Hospital

Association, and TJC. These updates include evidence-based recommendations categorized as

essential practices that should be adopted by all acute care hospitals, or additional approaches

that can be considered for use in locations and/or populations within hospitals when CLABSIs

are not controlled after implementation of essential practices (Infect Control Hosp Epidemiol.

2022;43(5):553-569).

Essential practices

care, and maintenance of CVCs.