Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

Claas Baier,Ralf-Peter Vonberg,Ella Ebadi,Iris Freya Chaberny,Matthias Eder,Lena Linke,Frank Schwab,Raffaele Serra

doi:10.1371/journal.pone.0227772

Abstract

Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (≤ 1000/μL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.

Highlights

Bloodstream infections (BSI) are quite common in patients with hemato-oncologic diseases as they are often severely immunocompromised due to the underlying disease, to antineoplastic therapy, and/or to hematopoietic stem cell transplantation (HSCT) [1,2,3]
Nosocomial BSIs are often associated with the usage of some kind of invasive device entering the venous blood system such as central vascular catheters (CVC) and are called central line-associated bloodstream infection (CLABSI) [4]
Patients with CLABSI had a longer mean overall hospital stay compared to non-CLABSI cases (47 vs. 22 days, p

Summary

Introduction

Bloodstream infections (BSI) are quite common in patients with hemato-oncologic diseases as they are often severely immunocompromised due to the underlying disease, to antineoplastic therapy, and/or to hematopoietic stem cell transplantation (HSCT) [1,2,3]. Nosocomial BSIs are often associated with the usage of some kind of invasive device entering the venous blood system such as central vascular catheters (CVC) and are called central line-associated bloodstream infection (CLABSI) [4]. One meta-analysis on mostly ICU patients suggests that.

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Conclusion