Skip to main content

Advertisement

SpringerLink
Log in

Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

To identify the attributable mortality of central line associated blood stream infections (CLABSI) through meta-analysis.

Methods

Meta-analysis of case control and cohort studies, matched and unmatched, that reported on mortality of patients with and without CLABSI was performed. MEDLINE, CENTRAL, CINAHL were searched. Non-interventional studies of all languages that reported mortality in patients with CLABSI were included. Data were extracted on patient population, study setting, design, diagnostic criteria for CLABSI, and mortality. Results from studies comparing mortality due to CLABSI were pooled using a random effects model with assessment of heterogeneity. Heterogeneity of studies was assessed with an I 2 statistic and a funnel plot was generated to assess for publication bias.

Results

Eighteen studies were included with 1,976 CLABSI cases. Of the included studies, 17 took place in intensive care unit settings, most involved a mixed population of medical and surgical patients, and ten were matched using an illness severity index. Our findings show an odds ratio of in hospital death associated with CLABSI as 2.75 (CI 1.86–4.07) and 1.51 (CI 1.08–2.09) in the subgroup of the ten matched studies. Those studies where greater than 30 % of CLABSI were attributed to coagulase-negative Staphylococcus had an odds ratio of death of 1.64 (95 % CI 1.02–2.65) compared with 4.71 (95 % CI 1.54–14.39).

Conclusions

CLABSI is associated with a significantly increased risk of death supporting the use of extensive efforts to reduce these infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pronovost P, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.

    Article  CAS  PubMed  Google Scholar 

  2. Mattie AS, Webster BL. Centers for Medicare and Medicaid Services’ “never events”: an analysis and recommendations to hospitals. Health Care Manag (Frederick). 2008;27(4):338–49.

    Google Scholar 

  3. Clancy CM. CMS’s hospital-acquired condition lists link hospital payment, patient safety. Am J Med Qual. 2009;24(2):166–8.

    Article  PubMed  Google Scholar 

  4. Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271(20):1598–601.

    Article  CAS  PubMed  Google Scholar 

  5. Arnow PM, Quimosing EM, Beach M. Consequences of intravascular catheter sepsis. Clin Infect Dis. 1993;16(6):778–84.

    Article  CAS  PubMed  Google Scholar 

  6. Collignon PJ. Intravascular catheter associated sepsis: a common problem. The Australian study on intravascular catheter associated sepsis. Med J Aust. 1994;161(6):374–8.

    CAS  PubMed  Google Scholar 

  7. Rello J, et al. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med. 2000;162(3 Pt 1):1027–30.

    Article  CAS  PubMed  Google Scholar 

  8. Cheewinmethasiri J, et al. Microbiology, risk factors and mortality of patients with intravenous catheter related blood stream infections in the surgical intensive care unit: a five-year, concurrent, case-controlled study. J Med Assoc Thai. 2014;97(Suppl 1):S93–101.

    PubMed  Google Scholar 

  9. Kumar A, et al. Diagnosis of central venous catheter-related bloodstream infection without catheter removal: a prospective observational study. Med J Armed Forces India. 2014;70(1):17–21.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Wittekamp BH, et al. Catheter-related bloodstream infections: a prospective observational study of central venous and arterial catheters. Scand J Infect Dis. 2013;45(10):738–45.

    Article  PubMed  Google Scholar 

  11. O’Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162–93.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W65–94.

    Article  PubMed  Google Scholar 

  13. Garner JS, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128–40.

    Article  CAS  PubMed  Google Scholar 

  14. Mermel LA, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Saint S, et al. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control. 2003;31(6):354–6.

    Article  PubMed  Google Scholar 

  16. Wells GA, Shea B, O’Connell D, Peterson K, Welch V, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. 2011.

  17. Blot SI, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005;41(11):1591–8.

    Article  PubMed  Google Scholar 

  18. Higuera F, et al. Attributable cost and length of stay for patients with central venous catheter-associated bloodstream infection in Mexico city intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol. 2007;28(1):31–5.

    Article  PubMed  Google Scholar 

  19. Hsu E, et al. Doing well by doing good: assessing the cost savings of an intervention to reduce central line-associated bloodstream infections in a Hawaii hospital. Am J Med Qual. 2013;29(1):13–9.

    Article  PubMed  Google Scholar 

  20. Leistner R, et al. Costs and prolonged length of stay of central venous catheter-associated bloodstream infections (CVC BSI): a matched prospective cohort study. Infection. 2013;42(1):31–6.

    Article  PubMed  Google Scholar 

  21. Olaechea PM, et al. Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients. Rev Esp Quim. 2013;26(1):21–9.

    Google Scholar 

  22. Rosenthal VD, et al. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control. 2003;31(8):475–80.

    Article  PubMed  Google Scholar 

  23. Stevens V, et al. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect. 2014;20(5):O318–24.

    Article  CAS  PubMed  Google Scholar 

  24. Warren DK, et al. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006;34(8):2084–9.

    Article  PubMed  Google Scholar 

  25. Hajjej Z, et al. Incidence, risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit. J Infect Chemother. 2014;20(3):163–8.

    Article  PubMed  Google Scholar 

  26. Dimick JB, et al. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg. 2001;136(2):229–34.

    Article  CAS  PubMed  Google Scholar 

  27. Pawar M, et al. Central venous catheter-related blood stream infections: incidence, risk factors, outcome, and associated pathogens. J Cardiothorac Vasc Anesth. 2004;18(3):304–8.

    Article  PubMed  Google Scholar 

  28. Renaud B, Brun-Buisson C, ICU-B.S. Group. Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit Care Med. 2001;163(7):1584–90.

    Article  CAS  PubMed  Google Scholar 

  29. Smith JW, et al. Central line-associated blood stream infection in the critically ill trauma patient. Am Surg. 2011;77(8):1038–42.

    PubMed  Google Scholar 

  30. Soufir L, et al. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol. 1999;20(6):396–401.

    Article  CAS  PubMed  Google Scholar 

  31. Siempos II, et al. Impact of catheter-related bloodstream infections on the mortality of critically ill patients: a meta-analysis. Crit Care Med. 2009;37(7):2283–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Thanks to Nestor Anguiano, MD for his assistance in translating Spanish language studies.

Conflict of interest

All authors report no conflicts of interest relevant to this article.

Author information

Authors and Affiliations

  1. William S. Middleton Memorial Veterans Hospital (NS), University of Wisconsin Medical School, Madison, WI, USA

    Matthew J. Ziegler, Daniela C. Pellegrini & Nasia Safdar

  2. Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, WI, USA

    Matthew J. Ziegler, Daniela C. Pellegrini & Nasia Safdar

  3. University of Wisconsin Hospital and Clinics, 1685 Highland Avenue, Madison, WI, 53705, USA

    Nasia Safdar

Authors
  1. Matthew J. Ziegler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniela C. Pellegrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nasia Safdar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nasia Safdar.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ziegler, M.J., Pellegrini, D.C. & Safdar, N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 43, 29–36 (2015). https://doi.org/10.1007/s15010-014-0689-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-014-0689-y

Keywords

Search

Navigation