Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.

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Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

Infection Control and Hospital Epidemiology ◽

10.1086/653028 ◽

2010 ◽

Vol 31 (11) ◽

pp. 1106-1114 ◽

Cited By ~ 8

Author(s):

Adrian G. Barnett ◽

Nicholas Graves ◽

Victor D. Rosenthal ◽

Reinaldo Salomao ◽

Manuel Sigfrido Rangel-Frausto

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Bloodstream Infection ◽

Latin American ◽

Severity Of Illness ◽

Central Line ◽

Risk Of Death ◽

Time Period ◽

Increased Risk ◽

Latin American Countries

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Central line associated bloodstream infection rates, extra length of stay, extra mortality and microbiological profile in a German tertiary intensive care unit: findings of the International Nosocomial Infection Control Consortium

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2010.02.2057 ◽

2010 ◽

Vol 14 ◽

pp. e256-e257

Author(s):

A.W. Friedrich ◽

R. Köck ◽

C. Goeters ◽

K. Becker ◽

K. Pohl ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Nosocomial Infection ◽

Infection Control ◽

Bloodstream Infection ◽

Central Line ◽

Infection Rates ◽

Microbiological Profile

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Impact of obesity on intensive care outcomes in patients with COVID-19 in Sweden—A cohort study

PLoS ONE ◽

10.1371/journal.pone.0257891 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257891

Author(s):

Lovisa Sjögren ◽

Erik Stenberg ◽

Meena Thuccani ◽

Jari Martikainen ◽

Christian Rylander ◽

...

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

High Body Mass Index ◽

Severity Of Illness ◽

Simplified Acute Physiology Score ◽

Composite Outcome ◽

Prolonged Length ◽

Logistic Regression Models ◽

Risk Of Death ◽

High Bmi

Background Previous studies have shown that a high body mass index (BMI) is a risk factor for severe COVID-19. The aim of the present study was to assess whether a high BMI affects the risk of death or prolonged length of stay (LOS) in patients with COVID-19 during intensive care in Sweden. Methods and findings In this observational, register-based study, we included patients with COVID-19 from the Swedish Intensive Care Registry admitted to intensive care units (ICUs) in Sweden. Outcomes assessed were death during intensive care and ICU LOS ≥14 days. We used logistic regression models to evaluate the association (odds ratio [OR] and 95% confidence interval [CI]) between BMI and the outcomes. Valid weight and height information could be retrieved in 1,649 patients (1,227 (74.4%) males) with COVID-19. We found a significant association between BMI and the risk of the composite outcome death or LOS ≥14 days in survivors (OR per standard deviation [SD] increase 1.30, 95%CI 1.16–1.44, adjusted for sex, age and comorbidities), and this association remained after further adjustment for severity of illness (simplified acute physiology score; SAPS3) at ICU admission (OR 1.30 per SD, 95%CI 1.17–1.45). Individuals with a BMI ≥ 35 kg/m2 had a doubled risk of the composite outcome. A high BMI was also associated with death during intensive care and a prolonged LOS in survivors assessed as separate outcomes. The main limitations were the restriction to the first wave of the pandemic, and the lack of information on socioeconomic status as well as smoking. Conclusions In this large cohort of Swedish ICU patients with COVID-19, a high BMI was associated with increasing risk of death and prolonged length of stay in the ICU. Based on our findings, we suggest that individuals with obesity should be more closely monitored when hospitalized for COVID-19.

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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

Infection Control and Hospital Epidemiology ◽

10.1086/657632 ◽

2011 ◽

Vol 32 (1) ◽

pp. 50-58 ◽

Cited By ~ 15

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.

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Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Epidemiology and Infection ◽

10.1017/s0950268811000094 ◽

2011 ◽

Vol 139 (11) ◽

pp. 1757-1763 ◽

Cited By ~ 15

Author(s):

V. D. ROSENTHAL ◽

F. E. UDWADIA ◽

H. J. MUÑOZ ◽

N. ERBEN ◽

F. HIGUERA ◽

...

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Meta Analysis ◽

Time Dependent ◽

Limited Resources ◽

Ventilator Associated Pneumonia ◽

Risk Of Death ◽

Patient Morbidity ◽

Increased Risk ◽

Time Dependent Analysis

SUMMARYVentilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2·03 days (95% CI 1·52–2·54 days), and increased the risk of death by 14% (95% CI 2–27). The increased risk of death due to VAP was explained by confounding with patient morbidity.

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Community-Onset Bloodstream Infection during the ‘After Hours’ Is not Associated with an increased Risk for Death

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2012/931737 ◽

2012 ◽

Vol 23 (4) ◽

pp. 170-172 ◽

Cited By ~ 2

Author(s):

Kevin B Laupland ◽

Pamela C Kibsey ◽

John C Galbraith

Keyword(s):

Bloodstream Infection ◽

Case Fatality ◽

Bloodstream Infections ◽

Multivariable Logistic Regression Model ◽

Risk Of Death ◽

Time Period ◽

Increased Risk ◽

Day Of The Week ◽

After Hours ◽

Community Onset

BACKGROUND/OBJECTIVE: Patients admitted to hospital during the ‘after hours’ (weekends and evenings) may be at increased risk for adverse outcome. The objective of the present study was to assess whether community-onset bloodstream infections presenting in the after hours are associated with death.METHODS: All patients in the Victoria area of British Columbia, who had first admissions with community-onset bloodstream infections between 1998 and 2005 were included. The day of admission to hospital, the day and time of culture draw, and all-cause, in-hospital mortality were ascertained.RESULTS: A total of 2108 patients were studied. Twenty-six per cent of patients were admitted on a weekend. Blood cultures were drawn on a weekend in 27% of cases and, in 43%, 33%, and 25% of cases, cultures were drawn during the day (08:00 to 17:59), the evening (18:00 to 22:59) and night (23:00 to 07:59), respectively. More than two-thirds (69%) of index cultures were drawn during the after hours (any time Saturday or Sunday and weekdays 18:00 to 07:59). The overall in-hospital case fatality rate was 13%. No difference in mortality was observed in relation to the day of the week of admission or time period of sampling. After-hours sampling was not associated with mortality in a multivariable logistic regression model examining factors associated with death.CONCLUSION: Presentation with community-onset, bloodstream infection during the after hours does not increase the risk of death.

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Faculty Opinions recommendation of Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14264133.15777271 ◽

2012 ◽

Author(s):

Theo Zaoutis

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Pediatric Patients ◽

Venous Catheter ◽

Central Line ◽

Central Venous ◽

Increased Risk

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Epidemiology of Central Line-Associated Bloodstream Infection (CLABSI) Among Patients in the Intensive Care Units (ICUs) at a Teaching Hospital in Saudi Arabia from Year 2011-2016

Journal of Intensive and Critical Care ◽

10.21767/2471-8505.100105 ◽

2018 ◽

Vol 04 (01) ◽

Cited By ~ 1

Author(s):

N Al Abdullah

Keyword(s):

Saudi Arabia ◽

Intensive Care ◽

Bloodstream Infection ◽

Intensive Care Units ◽

Teaching Hospital ◽

Central Line

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Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

Acta Médica Portuguesa ◽

10.20344/amp.5558 ◽

2016 ◽

Vol 29 (6) ◽

pp. 373

Author(s):

Jorge Rodrigues ◽

Andrea Dias ◽

Guiomar Oliveira ◽

José Farela Neves

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Bloodstream Infection ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Central Line ◽

Central Venous ◽

Group 2

Introduction: To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate. Material and Methods: A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 versus group 2). Results: Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter. Discussion: After multidimensional strategy implementation there was no reported central-line associated bloodstream infection Conclusions: Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.

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