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Unveiling the Hidden Threat: Understanding Central Line-Associated Bloodstream Infections Beyond Hospital Care

A comprehensive analysis of the multifaceted issue of central line-associated bloodstream infections (CLABSIs) in patients using long-term central venous catheters (CVCs) outside hospitals was revealed in this study by Oladapo-Shittu et al., ‘Characterizing patients presenting on hospital admission with central line-associated bloodstream infections: A Multicenter Study’, published by Infectious Diseases in March 2024. The significant mortality risks associated with CLABSIs necessitate the extensive collection and scrupulous examination of related data, particularly in the context of outpatient settings, such as home infusion therapy and oncology clinics, which remain a blind spot in current surveillance activities. 

This retrospective study represents a determined effort to enhance our understanding of the risks and challenges associated with managing CLABSIs outside of acute care hospitals. The study encompassed data from eleven hospitals across Maryland, Washington, DC, and Missouri, gathered over the November 2020 – October 2021 timeframe, involving 461 patients with CLABSI present on admission (POA). 

Central line-associated bloodstream infection (CLABSI) cases were identified using a modified definition related to acute care, and outcomes were ascertained using chart reviews. Cox regression was utilized to analyze all-cause mortality within 30 days. Notable outcomes of the study include the prevalence of Enterobacterales (29.2%) as the principal causative agent, a high in-patient mortality rate (11%), an increased mortality risk correlated with age groups and lack of insurance, and a significant reduction in mortality rates when CVC removal was implemented (HR 0.57, 95% CI 0.39-0.84). 

These compelling findings underscore the urgent need for rigorous surveillance systems for the early detection and prevention of CLABSIs in community settings, alongside the essential measures being taken in acute care hospitals. As professionals in infection prevention, expanding our field of view to encompass such non-hospital settings represents the next frontier in managing the pervasive challenge of CLABSIs, ultimately adding a significant contribution to public health.


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