Central venous catheter-related bloodstream infection and colonization: the impact of insertion site and distribution of multidrug-resistant pathogens

Abstract

Background: Placement of central-venous catheters (CVCs) is an essential practice in the management of hospitalized patients, however, insertion at the commonly used sites has often the potential of inducing major complications. Neverthelss, the impact of specific site central line catheter insertion on catheter-associated bloodstream infections (CLABSIs) has not been clarified yet in the literature.

Objective: The aim of the study was to compare CLABSIs and catheter colonization rates among the three catheter insertion sites: subclavian (SC), internal jugular (IJ) and femoral (FEM) in hospitalized patients. Moreover, to analyze the distribution of pathogens and their antimicrobial resistance profiles at these three sites, concurrently.

Methods: We performed a retrospective analysis of data collected prospectively from all catheterized patients at a tertiary care Greek hospital from May 2016 to May 2018. Data was collected on 1414 CVCs and 13,054 CVC-days.

Results: Τhe incidence of CLABSIs among the three sites was as follows: SC:5.1/1000 catheter/days, IJ: 3.73/1000 catheter/days and FEM: 6.93/1000 catheter/days (p = 0.37). The incidence of colonization was as follows: SC:13.39/1000 catheter/days; IJ:7.34/ 1000 catheter/days; FEM:22.91/1000 catheter/days (p = 0.009). MDROs predominated in both CLABSIs and tip colonizations (59.3 and 61%, respectively) with Acinetobacter baumanii being the predominant pathogen (16/59, 27.1% and 44/144, 30.5%, respectively). The incidence of CLABSIs due to multidrug-resistant organisms (MDROs) was as follows: SC:3.83/1000 catheter days; IJ:1.49/1000 catheter days; FEM:5.86/1000 catheter days (p = 0.04). The incidence of tip colonization by MDROs among the 3 sites was as follows: SC:8.93/1000 catheter/days; IJ:4.48/1000 catheter/days; FEM:12.79/1000 catheter/days (p = 0.06). There was no significant difference in the type of pathogen isolated among site groups for both CLABSIs and tip colonizations.

Conclusions: FEM site of catheter insertion was associated with a higher rate of bloodstream infection and catheters' colonization compared to IJ and SC sites. Furthermore, this survey highlights the changing trend of the distribution of frequent pathogens and resistance patterns towards MDR Gram-negative pathogens, underscoring the need for consistent monitoring of antimicrobial resistance patterns of these specific infections.

Keywords: Bloodstream infection; Catheter; Catheterization; Central venous catheter; Colonization; Insertion site; Sepsis.