title: Predictive factors for the development of central line-associated bloodstream infection due to gram-negative bacteria in intensive care unit patients after surgery.
abstract: OBJECTIVE
  To examine the relative proportions of central line-associated bloodstream infection (BSI) due to gram-negative bacteria and due to gram-positive bacteria among patients who had undergone surgery and patients who had not. The study also evaluated clinical predictive factors and unadjusted outcomes associated with central line-associated BSI caused by gram-negative bacteria in the postoperative period.
  
  
  METHODS
  Observational, case-control study based on a retrospective review of medical records.
  
  
  METHODS
  University of Chicago Medical Center, a 500-bed tertiary care center located on Chicago's south side.
  
  
  METHODS
  Adult intensive care unit (ICU) patients who developed central line-associated BSI.
  
  
  RESULTS
  There were a total of 142 adult patients who met the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System definition for central line-associated BSI. Of those, 66 patients (46.5%) had infections due to gram-positive bacteria, 49 patients (34.5%) had infections due to gram-negative bacteria, 23 patients (16.2%) had infections due to yeast, and 4 patients (2.8%) had mixed infections. Patients who underwent surgery were more likely to develop central line-associated BSI due to gram-negative bacteria within 28 days of the surgery, compared with patients who had not had surgery recently (57.6% vs 27.3%; P= .002). On multivariable logistic regression analysis, diabetes mellitus (adjusted odds ratio [OR], 4.6 [95% CI, 1.2-18.1]; P= .03) and the presence of hypotension at the time of the first blood culture positive for a pathogen (adjusted OR, 9.8 [95% CI, 2.5-39.1]; P= .001) were found to be independently predictive of central line-associated BSI caused by gram-negative bacteria. Unadjusted outcomes were not different in the group with BSI due to gram-negative pathogens, compared to the group with BSI due to gram-positive pathogens.
  
  
  CONCLUSIONS
  Clinicians caring for critically ill patients after surgery should be especially concerned about the possibility of central line-associated BSI caused by gram-negative pathogens. The presence of diabetes and hypotension appear to be significant associated factors.
authors.affiliation: Department of Infection Control,University of Chicago, Illinois, USA. sreeramoju@uthscsa.edu
authors.forename: Pranavi V
authors.initials: PV
authors.lastname: Sreeramoju
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Tolentino
authors.forename: Sylvia
authors.initials: S
authors.lastname: Garcia-Houchins
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Weber
mesh_terms: D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology*; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology; D004866:Equipment Contamination; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000209:etiology* / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000254:growth & development / Q000302:isolation & purification; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D011183:Postoperative Complications / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors