(1256) One Size Does Not Fit All When It Comes to CLABSI: Think Outside the Catheter!

Introduction: Central line-associated blood stream infection (CLABSI) is a rare, but devastating event for intensive care unit (ICU) patients. It can result in increased mortality rates, longer hospital stays, and reduced reimbursement from Medicare (1). Some CLABSIs captured by the CDC’s definition may be caused by infectious sources other than a central line (CVC), as has been found in the past, leading to challenges and changes to the definition (2,3). We aimed to assess the prevalence and outcomes of CLABSI in our institution’s surgical ICU and determine how many CLABSI cases were truly attributable to another source other than CVC.

Methods: Utilizing our institutional CLABSI database, we analyzed records of the patients from 2018-2022. The source of the infection was classified as CVC-related or other (GI, pulmonary, wound) based on the infectious disease physician’s assessment. Patient characteristics, type of catheter, infectious organism, reason for ICU admission, and mortality were collected. Descriptive statistics were performed with means for continuous variables and proportions for dichotomous variables.

Results: There were 41 CLABSI encounters during the project timeframe with 13 cases (31.7%) attributable to CVC, 25 cases (61%) associated with other sources, and 3 cases (7.3%) with unclear etiology. Enterococcus faecium, Enterococcus faecalis, and Candida were the three most common organisms cultured. Fourteen cases (34%) were found to be of GI origin. Sixteen out of 41 cases had dialysis catheters (39%), and 10 out of 41 patients had undergone organ transplant (24%). Overall, there were 18 fatalities. Twelve out of 25 CVC-unrelated CLABSI cases died (48%), while 5 out of 13 CVC-related CLABSI cases died (38%).

Conclusions: 61% of cases initially classified as CLABSI were caused by another infectious source suggesting that the current CLABSI definition may not be adequate. CLABSIs from CVC-unrelated sources also had higher mortality. While CVC insertion and care bundles need to be adhered to, changes in definition and focus on non-CVC related CLABSI have the potential to decrease blood stream infections and improve patient outcomes without penalizing the hospitals.
1. NHSN Device Associate Modules, Blood Stream Infections, Jan 2023
2. PMID: 26456954
3. PMCID: PMC6253127