Department of Pharmacy, Fujita Health University Nanakuri Memorial Hospital, Tsu, Japan;
Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Toyoake, Japan.
In Vivo. 2024 Nov-Dec;38(6):3041-3049. doi: 10.21873/invivo.13788.
BACKGROUND/AIM: Catheter-related bloodstream infections (CRBSI) are frequently life-threatening. Several factors have been reported to be related to CRBSI development; however, the factors associated with CRBSI mortality are unclear as they have rarely been studied. This study investigated the factors associated with mortality in patients with CRBSI, specifically focusing on nutritional factors.
This retrospective, multicenter study included in-patients with acute conditions and convalescent patients diagnosed with a CRBSI between January 2019 and December 2021 at 33 hospitals (23 general hospitals, two mixed-care hospitals, and eight convalescent hospitals). The primary outcome was death. Unadjusted and multivariable logistic regression analysis was performed to identify factors associated with mortality.
A total of 453 patients with CRBSI were enrolled. The causes of death were analyzed for 382 (84.3%) who survived CRBSI and 71 (15.7%) who died. Multivariable analysis revealed that Candida detected in blood culture [adjusted odds ratio (aOR)=2.72, 95% confidence interval (CI)=1.15-6.41; p=0.025)], CRBSI onset within 30 days of catheter insertion (aOR=2.28, 95% CI=1.27-4.09; p=0.005), concurrent infection (aOR=2.07, 95% CI=1.19-3.60; p=0.009), low serum albumin level (aOR=1.64, 95% CI=1.02-2.63; p=0.044), and elevated C-reactive protein level (aOR=1.05, 95% CI=1.01-1.10; p=0.028) were risk factors for mortality, whereas the use of a peripherally inserted central catheter was associated with a reduced risk of CRBSI mortality (aOR=0.30, 95% CI=0.13-0.69; p=0.004).
Enhanced monitoring of factors, such as candida detected in blood culture, CRBSI onset within 30 days of catheter insertion, concurrent infection, low serum albumin level, elevated C-reactive protein (CRP) level and the use of a peripherally inserted central catheter (PICC), is crucial for mitigating CRBSI severity and risk of death.
背景/目的：导管相关血流感染（CRBSI）常危及生命。已有报道称多种因素与 CRBSI 的发生有关，但与 CRBSI 死亡率相关的因素尚不清楚，因为很少有研究涉及这方面。本研究旨在探讨 CRBSI 患者死亡的相关因素，特别是关注营养因素。
本回顾性多中心研究纳入了 2019 年 1 月至 2021 年 12 月期间在 33 家医院（23 家综合医院、2 家混合护理医院和 8 家康复医院）住院的急性病和康复期患者，诊断为 CRBSI。主要结局为死亡。对所有患者进行了未调整和多变量逻辑回归分析，以确定与死亡率相关的因素。
共纳入 453 例 CRBSI 患者。对 382 例（84.3%）存活至 CRBSI 缓解和 71 例（15.7%）死亡的患者进行了死因分析。多变量分析显示，血培养中检出念珠菌（调整优势比[aOR]=2.72，95%置信区间[CI]：1.15-6.41；p=0.025]）、导管插入后 30 天内发生 CRBSI（aOR=2.28，95%CI：1.27-4.09；p=0.005）、合并感染（aOR=2.07，95%CI：1.19-3.60；p=0.009）、血清白蛋白水平降低（aOR=1.64，95%CI：1.02-2.63；p=0.044）和 C 反应蛋白（CRP）水平升高（aOR=1.05，95%CI：1.01-1.10；p=0.028）是死亡的危险因素，而使用外周静脉置入中心静脉导管（PICC）与降低 CRBSI 死亡率相关（aOR=0.30，95%CI：0.13-0.69；p=0.004）。
增强对血培养中检出念珠菌、导管插入后 30 天内发生 CRBSI、合并感染、血清白蛋白水平降低、CRP 水平升高和使用 PICC 等因素的监测，对于减轻 CRBSI 的严重程度和死亡风险至关重要。
