Impact of central-line-associated bloodstream infections and catheter-related bloodstream infections: a systematic review and meta-analysis

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-08-14 DOI:10.1016/j.jhin.2024.08.002

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Abstract

Background

Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs.

Aim

To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients.

Methods

PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E.

Findings

Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I² = 49%) and 2.47 (95% CI: 1.51, 4.02; I² = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I² = 91%) and 16.26 days (95% CI: 10.19, 22.33; I² = 66%), respectively.

Conclusion

CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS.

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中心管路相关血流感染和导管相关血流感染的影响：系统回顾和荟萃分析。

目的：健康经济模型的输入参数需要准确的效果估计。中心管路相关血流感染（CLABSIs）和导管相关血流感染（CRBSIs）是中心管路血流感染的不同定义，可能代表不同的患者，但之前的荟萃分析并未区分CLABSIs/CRBSIs。在这项荟萃分析中，我们提供了 CLABSI 和 CRBSI 患者与未感染患者相比的结果效应估计值：我们检索了 2000 年 1 月至 2024 年 3 月期间在 PubMed、EMBASE 和 CINAHL 上发表的全文研究，这些研究报告了感染 CLABSI/CRBSI 和未感染 CLABSI/CRBSI 的成人住院患者的全因死亡率和/或住院时间（LOS）。两名研究人员独立审查了所有可能相关的研究，并进行了数据提取。使用随机效应模型对死亡率和住院时间平均差异的比值进行汇总。使用 ROBINS-E 评估研究偏倚风险：我们纳入了 36 项研究。其中 16 项 CLABSI 和 12 项 CRBSI 研究报告了死亡率。与未感染患者相比，CLABSI和CRBSI的死亡率几率比分别为3.19（95% CI，2.44，4.16，I2=49%）和2.47（95% CI，1.51，4.02，I2=82%）。12项CLABSI研究和8项CRBSI研究报告了住院时间；只有3项CLABSI研究和2项CRBSI研究考虑了CLABSI/CRBSI的时间依赖性。与未感染患者相比，CLABSI和CRBSI患者的平均住院日分别为16.14天（95% CI，9.27，23.01，I2=91%）和16.26天（95% CI，10.19，22.33，I2=66%）：CLABSIs和CRBSIs会增加死亡风险和住院时间。已发表的研究很少考虑到 CLABSIs/CRBSIs 的时间依赖性，这可能导致过高估计超额住院时间。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.