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Predictive Factors for the Development of Central Line–Associated Bloodstream Infection Due to Gram-Negative Bacteria in Intensive Care Unit Patients After Surgery

Published online by Cambridge University Press:  02 January 2015

Pranavi V. Sreeramoju ,
Jocelyn Tolentino ,
Sylvia Garcia-Houchins  and
Stephen G. Weber
Pranavi V. Sreeramoju*
Affiliation:
Department of Medicine-Infectious Diseases, University of Chicago, Illinois Department of Medicine-Infectious Diseases, University of Texas Health Science Center, San Antonio
Jocelyn Tolentino
Affiliation:
Department of Infection Control, Medical Center, University of Chicago, Illinois
Sylvia Garcia-Houchins
Affiliation:
Department of Infection Control, Medical Center, University of Chicago, Illinois
Stephen G. Weber
Affiliation:
Department of Infection Control, Medical Center, University of Chicago, Illinois Department of Medicine-Infectious Diseases, University of Chicago, Illinois
*
7703 Floyd Curl Drive, MC 7881, San Antonio, TX 78229 ([email protected])
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Abstract

Objectives.

To examine the relative proportions of central line-associated bloodstream infection (BSI) due to gram-negative bacteria and due to gram-positive bacteria among patients who had undergone surgery and patients who had not. The study also evaluated clinical predictive factors and unadjusted outcomes associated with central line-associated BSI caused by gram-negative bacteria in the postoperative period.

Design.

Observational, case-control study based on a retrospective review of medical records.

Setting.

University of Chicago Medical Center, a 500-bed tertiary care center located on Chicago's south side.

Patients.

Adult intensive care unit (ICU) patients who developed central line-associated BSI.

Results.

There were a total of 142 adult patients who met the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System definition for central line-associated BSI. Of those, 66 patients (46.5%) had infections due to gram-positive bacteria, 49 patients (34.5%) had infections due to gram-negative bacteria, 23 patients (16.2%) had infections due to yeast, and 4 patients (2.8%) had mixed infections. Patients who underwent surgery were more likely to develop central line-associated BSI due to gram-negative bacteria within 28 days of the surgery, compared with patients who had not had surgery recently (57.6% vs 27.3%; P = .002). On multivariable logistic regression analysis, diabetes mellitus (adjusted odds ratio [OR], 4.6 [95% CI, 1.2-18.1]; P = .03) and the presence of hypotension at the time of the first blood culture positive for a pathogen (adjusted OR, 9.8 [95% CI, 2.5-39.1]; P = .001 ) were found to be independently predictive of central line-associated BSI caused by gram-negative bacteria. Unadjusted outcomes were not different in the group with BSI due to gram-negative pathogens, compared to the group with BSI due to gram-positive pathogens.

Conclusions.

Clinicians caring for critically ill patients after surgery should be especially concerned about the possibility of central line-associated BSI caused by gram-negative pathogens. The presence of diabetes and hypotension appear to be significant associated factors.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 1 , January 2008 , pp. 51 - 56
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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