Abstract：
Introduction: Central line-associated blood stream infection (CLABSI) is a hospital-acquired infection (HAI) associated with increased morbidity and mortality among the general patient population. However, few studies have evaluated the incidence, outcomes, and risk factors for CLABSI in trauma patients. This study aimed to identify the rate of positive (+)CLABSI in trauma patients and risk factors associated with (+)CLABSI. Methods: The 2017-2021 Trauma Quality Improvement Program database was queried for trauma patients aged ≥18 years undergoing central-line placement. We compared patients with (+)CLABSI vs. (-)CLABSI patients. Bivariate and multivariable logistic regression analyses were performed. Results: From 175,538 patients undergoing central-line placement, 469 (<0.1%) developed CLABSI. The (+)CLABSI patients had higher rates of cirrhosis (3.9% vs. 2.0%, p = 0.003) and chronic kidney disease (CKD) (4.3% vs. 2.6%, p = 0.02). The (+)CLABSI group had increased injury severity score (median: 25 vs. 13, p < 0.001), length of stay (LOS) (median 33.5 vs. 8 days, p < 0.001), intensive care unit LOS (median 21 vs. 6 days, p < 0.001), and mortality (23.7% vs. 19.6%, p = 0.03). Independent associated risk factors for (+)CLABSI included catheter-associated urinary tract infection (CAUTI) (odds ratio [OR] = 5.52, confidence interval [CI] = 3.81-8.01), ventilator-associated pneumonia (VAP) (OR = 4.43, CI = 3.42-5.75), surgical site infection (SSI) (OR = 3.66, CI = 2.55-5.25), small intestine injury (OR = 1.91, CI = 1.29-2.84), CKD (OR = 2.08, CI = 1.25-3.47), and cirrhosis (OR = 1.81, CI = 1.08-3.02) (all p < 0.05). Conclusion: Although CLABSI occurs in <0.1% of trauma patients with central-lines, it significantly impacts LOS and morbidity/mortality. The strongest associated risk factors for (+)CLABSI included HAIs (CAUTI/VAP/SSI), specific injuries (small intestine), and comorbidities. Providers should be aware of these risk factors with efforts made to prevent CLABSI in these patients.
摘要：
简介：中心线相关血流感染（CLABSI）是一种医院获得性感染（HAI），与普通患者人群的发病率和死亡率增加有关。然而,很少有研究评估发病率，结果，创伤患者CLABSI的危险因素。这项研究旨在确定创伤患者中（）CLABSI的阳性率以及与（）CLABSI相关的危险因素。方法:查询2017-2021年创伤质量改善计划数据库中年龄≥18岁的创伤患者行中线安置。我们比较了（+）CLABSI与（-）CLABSI患者。进行了双变量和多变量逻辑回归分析。结果：从175,538例接受中线放置的患者中，469（<0.1%）开发了CLABSI。（+）CLABSI患者肝硬化发生率较高（3.9%vs.2.0%,p=0.003）和慢性肾脏病（CKD）（4.3%vs.2.6%,p=0.02)。（+）CLABSI组的损伤严重程度评分增加（中位数：25vs.13，p<0.001)，住院时间（LOS）（中位数33.5vs.8天,p<0.001)，重症监护病房LOS（中位数21vs.6天,p<0.001)，和死亡率（23.7%vs.19.6%,p=0.03)。（+）CLABSI的独立相关危险因素包括导管相关尿路感染（CAUTI）（比值比[OR]=5.52，置信区间[CI]=3.81-8.01），呼吸机相关性肺炎（VAP）（OR=4.43，CI=3.42-5.75），手术部位感染（SSI）（OR=3.66，CI=2.55-5.25），小肠损伤（OR=1.91，CI=1.29-2.84），CKD（OR=2.08，CI=1.25-3.47），和肝硬化（OR=1.81，CI=1.08-3.02）（均p<0.05）。结论：尽管CLABSI发生在<0.1％的中央线创伤患者中，它显著影响LOS和发病率/死亡率。（+）CLABSI的最强相关风险因素包括HAIs（CAUTI/VAP/SSI），特定损伤（小肠），和合并症。提供者应意识到这些危险因素，并努力预防这些患者的CLABSI。
