title: The influence of intensive care unit-acquired central line-associated bloodstream infection on in-hospital mortality: A single-center risk-adjusted analysis.
abstract: To explore the risk-adjusted association between intensive care unit (ICU)-acquired central line-associated bloodstream infection (CLABSI) and in-hospital mortality.
  
  
  
  Retrospective observational study.
  
  
  
  Forty-five-bed adult ICU.
  
  
  
  All non-extracorporeal membrane oxygenation ICU admissions between July 1, 2008, and April 30, 2014, requiring a central venous catheter (CVC), with a length of stay > 48 hours, were included.
  
  
  
  Data were extracted from our infection prevention and ICU databases. A multivariable logistic regression model was constructed to identify independent risk factors for ICU-acquired CLABSI. The propensity toward developing CLABSI was then included in a logistic regression of in-hospital mortality.
  
  
  
  Six thousand three hundred fifty-three admissions were included. Forty-six cases of ICU-acquired CLABSI were identified. The overall CLABSI rate was 1.12 per 1,000 ICU CVC-days. Significant independent risk factors for ICU-acquired CLABSI included: double lumen catheter insertion (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.16-5.77), CVC exposure > 7 days (OR, 2.07; 95% CI, 1.06-4.04), and CVC insertion before 2011 (OR, 2.20; 95% CI, 1.22-3.97). ICU-acquired CLABSI was crudely associated with greater in-hospital mortality, although this was attenuated once the propensity to develop CLABSI was adjusted for (OR, 1.20; 95% CI, 0.54-2.68).
  
  
  
  A greater propensity toward ICU-acquired CLABSI was independently associated with higher in-hospital mortality, although line infection itself was not. The requirement for prolonged specialized central venous access appears to be a key risk factor for ICU-acquired CLABSI, and likely informs mortality as a marker of persistent organ dysfunction.
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia.
authors.forename: S W
authors.initials: SW
authors.lastname: Wong
authors.affiliation: Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Perioperative and Critical Care Services, Intensive Care Unit, Footscray Hospital, Footscray, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Gantner
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: McGloughlin
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Leong
authors.affiliation: Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia.
authors.forename: L J
authors.initials: LJ
authors.lastname: Worth
authors.affiliation: Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Klintworth
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Scheinkestel
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Pilcher
authors.affiliation: Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: Cheng
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia. Electronic address: a.udy@alfred.org.au.
authors.forename: A A
authors.initials: AA
authors.lastname: Udy
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000401:mortality*
keywords: Clinical outcomes; Critical care; Nosocomial infection