Rajandra Arulvani, Yunos Nor'azim Mohd, Teo Chin Hai, Kukreja Anjanna, Suhaimi Nur Alwani, Mohd Razali Siti Zuhairah, Basri Sazali, Teh Cindy Shuan Ju, Leong Chee Loon, Ismail Ismaliza, Azmel Azureen, Yunus Nor Hafizah Mohd, Rajahram Giri Shan, Ismail Abdul Jabbar, Deva Shanti Rudra, Kee Pei Wei, Ponnampalavanar Sasheela Sri La Sri
Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
Department of Anesthesiology, Universiti Malaya Medical Centre, Kuala Lumpur 50603, Malaysia.
Antibiotics (Basel). 2025 Mar 7;14(3):271. doi: 10.3390/antibiotics14030271.
Despite significant prevention efforts, the incidence of central line-associated bloodstream infection (CLABSI) in intensive care units (ICUs) is rising at an alarming rate. CLABSI contributes to increased morbidity, mortality, prolonged hospital stays and elevated healthcare costs. This study aimed to determine the incidence rate of CLABSI, compliance with the central venous catheter (CVC) care bundle and risk factors associated with CLABSI among ICU patients. This prospective observational study was conducted in one university hospital and two public hospitals in Malaysia between October 2022 to January 2023. Adult ICU patients (aged > 18 years) with CVC and admitted to the ICU for more than 48 h were included in this study. Data collected included patient demographics, clinical diagnosis, CVC details, compliance with CVC care bundle and microbiological results. All data analyses were performed using SPSS version 23. A total of 862 patients with 997 CVCs met the inclusion criteria, contributing to 4330 central line (CL) days and 18 CLABSI cases. The overall incidence rate of CLABSI was 4.16 per 1000 CL days. The average of overall compliance with CVC care bundle components was 65%. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (78.3%), followed by Gram-positive bacteria (17.4%) and spp. (2.0%). Multivariate analysis identified prolonged ICU stay (adjusted odds ratio (AOR): 1.994; 95% confidence interval (CI): 1.092-3.009), undergoing surgery (AOR: 2.02, 95% CI: 1.468-5.830) and having had multiple catheters (AOR: 3.167, 95% CI: 1.519-9.313) as significant risk factors for CLABSI. The findings underscore the importance of robust surveillance, embedded infection-control and -prevention initiatives, and strict adherence to the CVC care bundle to prevent CLABSI in ICUs. Targeted interventions addressing identified risk factors are crucial to improve patient outcomes and reduce healthcare costs.
尽管采取了大量预防措施，但重症监护病房（ICU）中心静脉导管相关血流感染（CLABSI）的发生率仍在以惊人的速度上升。CLABSI会导致发病率和死亡率增加、住院时间延长以及医疗成本上升。本研究旨在确定ICU患者中CLABSI的发生率、中心静脉导管（CVC）护理集束的依从性以及与CLABSI相关的危险因素。这项前瞻性观察性研究于2022年10月至2023年1月在马来西亚的一家大学医院和两家公立医院进行。本研究纳入了年龄大于18岁、留置CVC且入住ICU超过48小时的成年ICU患者。收集的数据包括患者人口统计学信息、临床诊断、CVC详细情况、CVC护理集束的依从性以及微生物学结果。所有数据分析均使用SPSS 23版进行。共有862例患者的997根CVC符合纳入标准，共计4330个中心静脉导管（CL）日，发生18例CLABSI。CLABSI的总体发生率为每1000个CL日4.16例。CVC护理集束各组成部分的总体平均依从率为65%。从CLABSI发作中分离出的主要致病微生物为革兰氏阴性菌（78.3%），其次是革兰氏阳性菌（17.4%）和其他菌属（2.0%）。多因素分析确定，ICU住院时间延长（调整优势比（AOR）：1.994；95%置信区间（CI）：1.092 - 3.009）、接受手术（AOR：2.02，95% CI：1.468 - 5.830）以及使用多根导管（AOR：3.167，95% CI：1.519 - 9.313）是CLABSI的重要危险因素。研究结果强调了进行有力监测、实施感染控制和预防举措以及严格遵守CVC护理集束以预防ICU中CLABSI的重要性。针对已确定危险因素的针对性干预措施对于改善患者预后和降低医疗成本至关重要。
