2417. Epidemiology of Central Line-Associated Bloodstream Infections Present on Hospital Admission: A Multicenter Study

Abstract

Abstract Background National estimates of central line-associated bloodstream infections (CLABSI) focus on acute care hospital settings. Little is known about CLABSI that develop outside of hospitals and are present on admission (CLABSI-POA). We aimed to describe the epidemiology of CLABSI-POA to develop appropriate prevention strategies. Methods We performed a retrospective cohort study of all adult and pediatric patients admitted from 11/01/2020 to 10/31/2021 in two large medical systems in the US, one in Maryland and one in Missouri. Adapting the National Healthcare Safety Network acute care CLABSI definition, we included patients who had a central venous catheter (CVC) present on admission (or had a CVC discontinued within 72 hours prior to admission) and a positive blood culture within 72 hours before and/or after admission. We performed descriptive statistics to characterize the epidemiology of CLABSI-POA. Results Of 402 patients with CLABSI-POA, 52% were male, 68% were age ≥45 years, and 45% had Medicare insurance as primary payer. Half of the cases had a hospitalization 30 days prior to the index admission, 22% had at least one prior CLABSI, and 40% received chemotherapy in the last 6 months. The most common indications for catheter placement were chemotherapy (34%), total parenteral nutrition (21%), dialysis (15%), and outpatient parenteral antimicrobial therapy (11%). Attribution of CLABSI-POA based on site where the catheter was routinely accessed included oncology clinics (34%), home infusion therapy (32%), hemodialysis centers (12%), and skilled nursing facilities (9%). The most common causative microorganisms were coagulase-negative staphylococci (23%), Staphylococcus aureus (21%), Enterococcus spp. (12%), Candida spp. (11%), Escherichia coli and Klebsiella pneumoniae (10% each), and Pseudomonas aeruginosa (7%). Forty-five (11%) cases were due to multidrug resistant organisms. Overall in-hospital mortality was 10%. Conclusion CLABSI-POA were common in those attending oncology clinics and receiving home infusion therapy. Lack of routine surveillance of CLABSI-POAs leads to an underestimation of the burden of CLABSIs in the healthcare system. Tailored prevention strategies should be focused in those groups at higher risk. Disclosures Stephanie Mayoryk, MAS BSN RN CIC, PDI: Honoraria Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Carlos Mejia-Chew, MD, INSMED: Grant/Research Support|RevImmune: Grant/Research Support Sara C. Keller, MD, MPH, MSPH, Pfizer: Advisor/Consultant