title: Factors predicting the cause and prognosis of central line-associated bloodstream infections.
abstract: The increased use of indwelling catheters has led to an increased number of deaths due to central line-associated bloodstream infection (CLABSI). Improving CLABSI outcomes requires the identification of clinical characteristics affecting drug selection and factors associated with poor prognosis. The medical records of inpatients admitted to St. Marianna University School of Medicine between April 1, 2010 and March 31, 2013 were evaluated for the results of catheter tip cultures. The clinical characteristics of these cases and the characteristics of the pathogens involved were investigated to identify prognostic factors. Of the 1629 catheter cultures investigated, 183 were CLABSIs. Among them, 105 were caused by gram-positive bacteria, 43 by gram-negative bacteria, and 35 by fungi. Gram-negative CLABSIs were more common in cases with prior colonization by gram-negative bacteria and post-surgical cases. Fungal CLASBIs were more common in the cases with prior colonization by fungi, high-calorie infusion enforcement, broad-spectrum antibiotic treatment, and post-surgical cases. Death was significantly more likely in cases with findings of inflammation at the catheter insertion site and in those with abnormal body temperature, tachycardia, or abnormal white blood cell count. Thus, when treating CLABSI in post-surgical cases and in cases with prior colonization by gram-negative bacteria, therapy should include anti-pseudomonal agents. Considering the factors predicting poor prognostic identified in this study, clinicians must check the vital signs and catheter insertion site in patients with indwelling catheters.
authors.affiliation: Division of General Internal Medicine, St. Marianna University School of Medicine, Japan. Electronic address: taka_pisces_heart@yahoo.co.jp.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: Division of General Internal Medicine, St. Marianna University School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kunishima
authors.affiliation: Division of General Internal Medicine, St. Marianna University School of Medicine, Japan.
authors.forename: Gohji
authors.initials: G
authors.lastname: Shimizu
authors.affiliation: Division of General Internal Medicine, St. Marianna University School of Medicine, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Hirose
authors.affiliation: Division of General Internal Medicine, St. Marianna University School of Medicine, Japan.
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Yamasaki
authors.affiliation: Division of General Internal Medicine, St. Marianna University School of Medicine, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nishisako
authors.affiliation: Division of Infection Control, St. Marianna University School of Medicine, Japan.
authors.forename: Taeko
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Division of General Internal Medicine, St. Marianna University School of Medicine, Japan.
authors.forename: Takahide
authors.initials: T
authors.lastname: Matsuda
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D001419:Bacteria / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology; D016469:Fungemia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Central line-associated bloodstream infection (CLABSI); Pathogens of CLABSI; Prognosis of CLABSI