Comparing central line-associated bloodstream infections caused by Candida to bacteria in hospitalized patients at two university hospitals Público

Abstract

Background: While central line-associated blood stream infection (CLABSI) rates have decreased nationally, the proportion of CLABSIs due to Candida has increased. We sought to determine risk factors for CLABSI due to Candida when compared to bacteria, and assess the impact on mortality. We hypothesized that having multiple central lines were an independent risk factor for CLABSI due to Candida.

Methods: Data on patients with CLABSI at two 500-bed hospitals from 12/1/2009 to 6/30/2011 were extracted from an existing database and a supplemental chart review was performed. Patients with neutropenia, lymphoma, or leukemia were excluded due to significant clinical differences in this group. Chi square, Fisher's exact test, and multiple logistic regression were used to determine the strengths of association of variables on CLABSI with Candida compared with bacteria. We examined the impact on 30 day mortality of CLABSI due to Candida compared to bacteria by performing a Kaplan-Meier curve and utilizing Cox proportional hazard models.

Results: Univariate analysis revealed no significant difference in odds of having multiple central lines when comparing CLABSI due to Candida and bacteria, however, adjusted odds of multiple central lines was significant in multivariate analysis. Significant predictors in multivariate analysis include: Broad spectrum antibiotics (aOR 8.15 CI 3.11 - 21.37), pulmonary disease (aOR 4.71 CI 1.51 - 14 .66), non-tunneled dialysis catheters (aOR 3.60 CI 1.01 - 12.82), mechanical ventilation (aOR 2.90 CI 1.15 - 7.32), blood transfusion (aOR 2.70 CI 1.18 - 6.54), silver coated needleless connectors (aOR 2.65 CI 1.09 - 6.49), and TPN (aOR 2.47 CI 1.00 - 6.10). Thirty day mortality was higher for patients with CLABSI due to Candida but not significant when accounting for prior ICU stay.

Conclusions: Multiple central lines may be more predictive of CLABSI due to bacteria rather than Candida spp. when accounting for other significant risk factors. Further studies examining the effect that antibiotic stewardship programs have on CLABSI due to Candida are warranted.

Table of Contents

INTRODUCTION. 1

BACKGROUND. 2

METHODS. 5

RESULTS. 10

DISCUSSION. 13

REFERENCES. 17

TABLE 1. 20

TABLE 2. 21

TABLE 3. 22

TABLE 4. 23

TABLE 5. 24

TABLE 6. 25

TABLE 7. 26

FIGURE 1. 27

FIGURE 2. 28

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Biology, Microbiology Health Sciences, Epidemiology
Palabra Clave	infection control candidemia CLABSI central line-associated bloodstream infection hospital acquired infection bacteremia hospital epidemiology
Committee Chair / Thesis Advisor	Jacob, Jesse Thomas, Emory University Steinberg, James Paul, Emory University
Committee Members	Esper, Annette , Emory University Manatunga, Amita, Emory University

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