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

Infection ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Matthew J. Ziegler ◽  
Daniela C. Pellegrini ◽  
Nasia Safdar
Keyword(s):  
Systematic Review ◽  
Bloodstream Infection ◽  
Meta Analysis ◽  
Central Line ◽  
Attributable Mortality

Impact of Switching from an Open to a Closed Infusion System on Rates of Central Line–Associated Bloodstream Infection: A Meta-analysis of Time-Sequence Cohort Studies in 4 Countries

2011 ◽  
Vol 32 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Dennis G. Maki ◽  
Victor D. Rosenthal ◽  
Reinaldo Salomao ◽  
Fabio Franzetti ◽  
Manuel Sigfrido Rangel-Frausto
Keyword(s):  
Cohort Studies ◽  
Bloodstream Infection ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Central Line ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Icu Mortality ◽  
Increased Risk ◽  
The Impact

Background.We report a meta-analysis of 4 identical time-series cohort studies of the impact of switching from use of open infusion containers (glass bottle, burette, or semirigid plastic bottle) to closed infusion containers (fully collapsible plastic containers) on central line-associated bloodstream infection (CLABSI) rates and all-cause intensive care unit (ICU) mortality in 15 adult ICUs in Argentina, Brazil, Italy, and Mexico.Methods.All ICUs used open infusion containers for 6–12 months, followed by switching to closed containers. Patient characteristics, adherence to infection control practices, CLABSI rates, and ICU mortality during the 2 periods were compared by χ2test for each country, and the results were combined using meta-analysis.Results.Similar numbers of patients participated in 2 periods (2,237 and 2,136). Patients in each period had comparable Average Severity of Illness Scores, risk factors for CLABSI, hand hygiene adherence, central line care, and mean duration of central line placement. CLABSI incidence dropped markedly in all 4 countries after switching from an open to a closed infusion container (pooled results, from 10.1 to 3.3 CLABSIs per 1,000 central line-days; relative risk [RR], 0.33 [95% confidence interval {CI}, 0.24-0.46];P<.001). All-cause ICU mortality also decreased significantiy, from 22.0 to 16.9 deaths per 100 patients (RR, 0.77 [95% CI, 0.68-0.87];P<.001).Conclusions.Switching from an open to a closed infusion container resulted in a striking reduction in the overall CLABSI incidence and all-cause ICU mortality. Data suggest that open infusion containers are associated with a greatiy increased risk of infusion-related bloodstream infection and increased ICU mortality that have been unrecognized. Furthermore, data suggest CLABSIs are associated with significant attributable mortality.

scholarly journals Length of stay, cost, and mortality of healthcare-acquired bloodstream infections in children and neonates: A systematic review and meta-analysis

2020 ◽  
Vol 41 (3) ◽  
pp. 342-354 ◽  
Author(s):  
Sofia Karagiannidou ◽  
Christos Triantafyllou ◽  
Theoklis E. Zaoutis ◽  
Vassiliki Papaevangelou ◽  
Nikolaos Maniadakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Healthcare Cost ◽  
Meta Analysis ◽  
Random Effect ◽  
Bloodstream Infections ◽  
Attributable Mortality ◽  
Study Selection ◽  
Critical Appraisal Skills

AbstractObjective:To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs).Design:A systematic review and meta-analysis.Methods:A systematic search (January 2000–September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case–control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated.Results:In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70–20.11) and the pooled attributable mortality rate was 8% (95% CI, 6–9). A meta-analysis was not conducted for cost due to lack of eligible studies.Conclusions:Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.

Clinical impact of needle-free connector design: A systematic review of literature

2020 ◽  
Vol 21 (6) ◽  
pp. 847-853 ◽  
Author(s):  
Victor Daniel Rosenthal
Keyword(s):  
Systematic Review ◽  
Bloodstream Infection ◽  
Systematic Reviews ◽  
Microbial Contamination ◽  
Open Systems ◽  
Central Line ◽  
Adverse Outcomes ◽  
Infection Rates ◽  
Positive Displacement ◽  
Control And Prevention

The objective of this systematic review is to analyze types of needle-free connectors and open systems and their effects on central line–associated bloodstream infection rates and other adverse outcomes through a research protocol consistent with the Preferred Reporting Items for Systematic Reviews’ recommendations. MEDLINE and Cochrane databases of systematic reviews were searched for relevant comparative studies published from January 2000 to September 2017. Eighteen studies compared central line–associated bloodstream infection (according to the Centers for Disease Control and Prevention/National Healthcare Safety Network definition), internal microbial contamination, occlusions, phlebitis, and other outcomes associated with needle-free connectors with a positive displacement device, negative displacement device, neutral displacement device, or three-way stopcock. Ten studies reported central line–associated bloodstream infection rates, which were lower with positive displacement devices versus negative displacement devices/neutral displacement devices (one study) and with negative displacement devices versus three-way stopcocks (three studies), but varied with different positive displacement device and negative displacement device/neutral displacement device designs (four studies). Seven studies reported internal microbial contamination rates, which were higher with three-way stopcocks versus negative displacement devices (two studies) and positive displacement devices (two studies), lower when positive displacement devices were used versus neutral displacement devices (one study), and varied with different types of negative displacement device (one study). Central line–associated bloodstream infection rates and most other outcomes analyzed were statistically significantly higher with three-way stopcocks (open devices) versus positive displacement device, negative displacement devices, and neutral displacement devices, but varied among closed device designs.

Health outcomes attributable to carbapenemase-producing Enterobacteriaceae infections: A systematic review and meta-analysis

2019 ◽  
Vol 41 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Dalton R. Budhram ◽  
Stephen Mac ◽  
Joanna M. Bielecki ◽  
Samir N. Patel ◽  
Beate Sander
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Hospital Mortality ◽  
Health Outcomes ◽  
Bloodstream Infection ◽  
Meta Analysis ◽  
Quality Appraisal ◽  
Reported Health

AbstractBackground:Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat.Objective:To conduct a systematic review of health outcomes and long-term sequelae attributable to CPE infection.Methods:We followed PRISMA reporting guidelines and published our review protocol on PROSPERO (CRD42018097357). We searched Medline, Embase, CINAHL and the Cochrane Library. We included primary studies with a carbapenem-susceptible control group in high-income countries, published in English. Quality appraisal was completed using Joanna Briggs Institute checklists. We qualitatively summarized frequently reported outcomes and conducted a meta-analysis.Results:Our systematic review identified 8,671 studies; 17 met the eligibility criteria for inclusion. All studies reported health outcomes; none reported health-related quality-of-life. Most studies were from Europe (65%), were conducted in teaching or university-affiliated hospitals (76%), and used case-control designs (53%). Mortality was the most commonly reported consequence of CPE-infections; in-hospital mortality was most often reported (62%). Our meta-analysis (n = 5 studies) estimated an absolute risk difference (ARD) for in-hospital bloodstream infection mortality of 0.25 (95% confidence interval [CI], 0.17–0.32). Duration of antibiotic therapy (range, 4–29.7 vs 1–23.6 days) and length of hospital stay (range, 21–87 vs 15–43 days) were relatively higher for CPE-infected patients than for patients infected with carbapenem-susceptible pathogens. Most studies (82%) met >80% of their respective quality appraisal criteria.Conclusions:The risk of in-hospital mortality due to CPE bloodstream infection is considerably greater than carbapenem-susceptible bloodstream infection (ARD, 0.25; 95% CI, 0.17–0.32). Health outcome studies associated with CPE infection are focused on short-term (eg, in-hospital) outcomes; long-term sequelae and quality-of-life are not well studied.Trial Registration:PROSPERO (CRD42018097357).

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