Risk Factor for Central Line Associated Bloodstream Infections in 9 Asian Countries

Background: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors (RF) in Asia.

Methods: From 03/27/2004 to 02/11/2022, we conducted a multinational multicenter prospective cohort study in 281 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam). For estimation of CLABSI rate we used CL-days as denominator and number of CLABSI as numerator. To estimate CLABSI RF for we analyzed the data using multiple logistic regression, and outcomes are shown as adjusted odds ratios (aOR).

Results: 150,142 patients, hospitalized 853,604 days, acquired 1,514 CLABSIs. Pooled CLABSI rate per 1,000 CL-days was 5.08; per type of catheter were: femoral: 6.23; temporary hemodialysis: 4.08; jugular: 4.01; arterial: 3.14; PICC: 2.47; subclavian: 2.02. The highest rates were femoral, temporary for hemodialysis, and jugular, and the lowest PICC and subclavian. We analyzed following variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization ratio, CL-type, tracheostomy use, hospitalization type, ICU type, facility ownership and World Bank classifications by income level. Following were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 4% daily (aOR=1.04; 95%CI=1.03-1.04;p<0.0001); number of CL-days before CLABSI acquisition, rising risk 5% per CL-day (aOR=1.05;95%CI=1.05-1.06;p<0.0001); medical hospitalization (aOR=1.21;95%CI=1.04-1.39;p=0.01); tracheostomy use (aOR=2.02;95%CI=1.43-2.86;p<0.0001); publicly-owned facility (aOR=3.63;95%CI=2.54-5.18;p<0.0001); lower-middle-income country (aOR=1.87;95%CI=1.41-2.47; p<0.0001). ICU with highest risk was pediatric  (aOR=2.86; 95%CI=1.71-4.82;p<0.0001), followed by medical-surgical (aOR=2.46;95%CI=1.62-3.75;p<0.0001). CL with the highest risk were internal-jugular (aOR=3.32;95%CI=2.84-3.88;p<0.0001), and femoral (aOR=3.13;95%CI=2.48-3.95;p<0.0001), and subclavian (aOR=1.78;95%CI=1.47-2.15;p<0.0001) showed the lowest risk.

Conclusions: The following CLABSI RFs are unlikely to change: country income level, facility-ownership, hospitalization type, and ICU type. Based on these findings it is suggested to focus on reducing LOS, CL-days, and tracheostomy; using subclavian or PICC instead of internal-jugular or femoral; and implementing evidence-based CLABSI prevention recommendations.


Title: Rosenthal Vd, Ruijie Yin, Camilla Rodrigues, Sheila Nainan Myatra, Jigeeshu VasishthDivatia, Sanjay K Biswas, Anjana Mahesh Shrivastava, Mohit Kharbanda, Bikas Nag, Yatin Mehta, Smita Sarma, Subhash Kumar Todi, Mahuya Bhattacharyya, Arpita Bhakta, Chin Seng, Gan, Michelle Siu Yee, Low, Marissa, Bt Madzlan Kushairi, Soo Lin, Chuah, Qi Yuee, Wang, Rajesh Chawla, Aakanksha Chawla Jain, Sudha Kansal, Roseleen Kaur Bali, Rajalakshmi Arjun, Narangarav Davaadagva, Ider Bat-Erdene, Tsolmon Begzjav, Mat Nor, Mohd Basri, Chian-Wern, Tai , Pei-Chuen, Lee, Swee-Fong, Tang, Kavita Sandhu, Binesh Badyal, Ankush Arora, Deep Sengupta, Lili Tao, Zhilin Jin. Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections over 18 years in 281 ICUs of 9 Asian countries. Journal Of Vascular Access. Accepted for publication and in Press. 2023.

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