Risk factors for catheter-related bloodstream infections with short-term central venous catheters in critically ill adult patients: A multicentre cohort study in China.

INTRODUCTION

Central venous catheters (CVCs) are widely used in intensive care units (ICUs) but are associated with catheter-related bloodstream infections (CRBSIs), a critical complication affecting patient outcomes. While prolonged CVC use is recognised as a risk factor, evidence for short-term placement (<14 days) remains limited, hindering targeted prevention strategies.

METHODS

A prospective multicentrer cohort study was conducted across 20 tertiary hospitals (12 Chinese provinces, September 2023-February 2024). Critically ill adult patients (≥18 years old) with ICU stays exceeding 48 h and with indwelling CVCs for ≥24 h were included, excluding those with pre-existing CVCs from other facilities, haemodialysis catheters, or prior CRBSI. Data on demographics, comorbidities, therapeutic interventions, and CVC characteristics were collected. Univariable and multivariable Cox models analysed CRBSI risk factors, with a subgroup analysis focusing on first-time CVC insertions.

RESULTS

In total, 2426 patients (2669 CVCs) were included; 29 (1.2%) had CRBSI (85.83/100,000 person-days). Independent CRBSI risks were as follows: age ≥75 years (hazard ratio [HR] = 2.94, 95% confidence interval [CI] = 1.11-7.78), multiple CVCs (dose-dependent: 2 catheters HR = 2.84; 3 catheters HR = 6.46; 4 catheters HR = 13.89), parenteral nutrition (HR = 2.87, 95% CI = 1.13-7.25), immunosuppressants (HR = 3.27, 95% CI = 1.51-7.10), and mechanical ventilation (HR = 4.52, 95% CI = 1.04-19.60). A subgroup analysis (excluding multiple CVCs) showed similar CRBSI risks for internal jugular (42.84/100,000 person-days) and subclavian veins (31.04/100,000 person-days; P = 0.633) and higher risks for femoral (HR = 5.42, 95% CI = 1.09-26.87) and axillary veins (HR = 7.05, 95% CI = 1.18-42.22).

CONCLUSION

Advanced age, multiple CVCs, parenteral nutrition, immunosuppressants, and mechanical ventilation were associated with higher CRBSI risk during the early phase of CVC use. Internal jugular placement showed lower risk than subclavian, while femoral and axillary sites had numerically higher estimates. Notably, the low overall CRBSI incidence reflects successful implementation of prevention practices in China, though the risk associations should be considered exploratory due to limited events.