Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

Autoři: Claas Baier aff001;  Lena Linke aff001;  Matthias Eder aff002;  Frank Schwab aff003;  Iris Freya Chaberny aff004;  Ralf-Peter Vonberg aff001;  Ella Ebadi aff001
Působiště autorů: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany aff001;  Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany aff002;  Institute of Hygiene and Environmental Medicine, Charité - University Medicine, Berlin, Germany aff003;  Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227772


Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (≤ 1000/μL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.

Klíčová slova:

Acute myeloid leukemia – Bloodstream infections – Cancer risk factors – Catheters – Hematology – Jugular vein – Medical risk factors – Nosocomial infections


1. Heinz WJ, Buchheidt D, Christopeit M, von Lilienfeld-Toal M, Cornely OA, Einsele H, et al. Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann. Hematol. 2017;96:1775–92. doi: 10.1007/s00277-017-3098-3 28856437

2. Dettenkofer M, Wenzler‐Rottele S, Babikir R, Bertz H, Ebner W, Meyer E, et al. Surveillance of Nosocomial Sepsis and Pneumonia in Patients with a Bone Marrow or Peripheral Blood Stem Cell Transplant: A Multicenter Project. Clin. Infect. Dis. 2005;40:926–31. doi: 10.1086/428046 15824981

3. Rhee Y, Heung M, Chen B, Chenoweth CE. Central line-associated bloodstream infections in non-ICU inpatient wards: A 2-year analysis. Infect. Control Hosp. Epidemiol. 2015;36:424–30. doi: 10.1017/ice.2014.86 25782897

4. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30:62–7. doi: 10.1007/s00134-003-2045-z 14647886

5. Ziegler MJ, Pellegrini DC, Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection. 2015;43:29–36. doi: 10.1007/s15010-014-0689-y 25331552

6. Snarski E, Mank A, Iacobelli S, Hoek J, Styczyński J, Babic A, et al. Current practices used for the prevention of central venous catheter-associated infection in hematopoietic stem cell transplantation recipients: A survey from the Infectious Diseases Working Party and Nurses’ Group of EBMT. Transpl. Infect. Dis. 2015;17:558–65. doi: 10.1111/tid.12399 25953418

7. Lü Y, Cai MH, Cheng J, Zou K, Xiang Q, Wu JY, et al. A multi-center nested case-control study on hospitalization costs and length of stay due to healthcare-associated infection. Antimicrob. Resist. Infect. Control. 2018;7:99. doi: 10.1186/s13756-018-0386-1 30116526

8. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern. Med. 2013;173:2039–46. doi: 10.1001/jamainternmed.2013.9763 23999949

9. Wolf H-H, Leithäuser M, Maschmeyer G, Salwender H, Klein U, Chaberny I, et al. Central venous catheter-related infections in hematology and oncology: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann. Hematol. 2008;87:863–76. doi: 10.1007/s00277-008-0509-5 18629501

10. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control. 2008;36:309–32. doi: 10.1016/j.ajic.2008.03.002 18538699

11. Tarpatzi A, Avlamis A, Papaparaskevas J, Daikos GL, Stefanou I, Katsandri A, et al. Incidence and risk factors for central vascular catheter-related bloodstream infections in a tertiary care hospital. New Microbiol. 2012;35:429–37. 23109010

12. Mollee P, Jones M, Stackelroth J, van Kuilenburg R, Joubert W, Faoagali J, et al. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J. Hosp. Infect. 2011;78:26–30. doi: 10.1016/j.jhin.2011.01.018 21459476

13. Luft D, Schmoor C, Wilson C, Widmer AF, Bertz H, Frei R, et al. Central venous catheter-associated bloodstream infection and colonisation of insertion site and catheter tip. What are the rates and risk factors in haematology patients? Ann. Hematol. 2010;89:1265–75. doi: 10.1007/s00277-010-1005-2 20532506

14. Blennow O, Ljungman P, Sparrelid E, Mattsson J, Remberger M. Incidence, risk factors, and outcome of bloodstream infections during the pre-engraftment phase in 521 allogeneic hematopoietic stem cell transplantations. Transpl. Infect. Dis. 2014;16:106–14. doi: 10.1111/tid.12175 24372809

15. Ielapi N, Nicoletti E, Lorè C, Guasticchi G, Avenoso T, Barbetta A, et al. The Role of Biofilm In Central Venous Catheter Related Bloodstream Infections: Evidence Based Nursing And Review of The Literature. Rev. Recent Clin. Trials. 2019 Oct 18 doi: 10.2174/1574887114666191018144739 31656155

16. Blot F, Nitenberg G, Chachaty E, Raynard B, Germann N, Antoun S, et al. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet. 1999;354:1071–7. doi: 10.1016/s0140-6736(98)11134-0 10509498

17. Nosari AM, Nador G, de Gasperi A, Ortisi G, Volonterio A, Cantoni S, et al. Prospective monocentric study of non-tunnelled central venous catheter-related complications in hematological patients. Leuk. Lymphoma. 2008;49:2148–55. doi: 10.1080/10428190802409930 19021058

18. Meyer E, Beyersmann J, Bertz H, Wenzler-Röttele S, Babikir R, Schumacher M, et al. Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation. Bone Marrow Transplant. 2007;39:173–8. doi: 10.1038/sj.bmt.1705561 17245425

19. Howell PB, Walters PE, Donowitz GR, Farr BM. Risk factors for infection of adult patients with cancer who have tunnelled central venous catheters. Cancer. 1995;75:1367–75. doi: 10.1002/1097-0142(19950315)75:6<1367::aid-cncr2820750620>;2-z 7882288

20. Shaul DB, Scheer B, Rokhsar S, Jones VA, Chan LS, Boody BA, et al. Risk factors for early infection of central venous catheters in pediatric patients. J. Am. Coll. Surg. 1998;186:654–8. doi: 10.1016/s1072-7515(98)00096-9 9632153

21. Miliaraki M, Katzilakis N, Chranioti I, Stratigaki M, Koutsaki M, Psarrou M, et al. Central line-associated bloodstream infection in childhood malignancy: Single-center experience. Pediatr. Int. 2017;59:769–75. doi: 10.1111/ped.13289 28376269

22. Huang C-T, Liu C-J, Ko P-S, Liu H-T, Yu Y-B, Hsiao L-T, et al. Risk factors and characteristics of blood stream infections in patients with newly diagnosed multiple myeloma. BMC Infect. Dis. 2017;17:33. doi: 10.1186/s12879-016-2155-1 28056867

23. Kelly M, Conway M, Wirth K, Potter-Bynoe G, Billett AL, Sandora TJ. Moving CLABSI prevention beyond the intensive care unit: risk factors in pediatric oncology patients. Infect. Control Hosp. Epidemiol. 2011;32:1079–85. doi: 10.1086/662376 22011534

24. Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N. Engl. J. Med. 2015;373:1220–9. doi: 10.1056/NEJMoa1500964 26398070

25. Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patients—A randomized controlled trial. JAMA. 2001;286:700–7. doi: 10.1001/jama.286.6.700 11495620

26. Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: A systematic review of the literature and meta-analysis. Crit. Care Med. 2012;40:2479–85. doi: 10.1097/CCM.0b013e318255d9bc 22809915

27. Arvaniti K, Lathyris D, Blot S, Apostolidou-Kiouti F, Koulenti D, Haidich A-B. Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients: A Pairwise and Network Meta-Analysis. Crit. Care Med. 2017;45:e437–48. doi: 10.1097/CCM.0000000000002092 27632678

28. Wylie MC, Graham DA, Potter-Bynoe G, Kleinman ME, Randolph AG, Costello JM, et al. Risk Factors for Central Line–Associated Bloodstream Infection in Pediatric Intensive Care Units. Infect. Control Hosp. Epidemiol. 2010;31:1049–56. doi: 10.1086/656246 20731595

29. Hanna HA, Raad I. Blood products: a significant risk factor for long-term catheter-related bloodstream infections in cancer patients. Infect. Control Hosp. Epidemiol. 2001;22:165–6. doi: 10.1086/501885 11310696

30. Leistner R, Hirsemann E, Bloch A, Gastmeier P, Geffers C. Costs and prolonged length of stay of central venous catheter-associated bloodstream infections (CVC BSI): A matched prospective cohort study. Infection. 2014;42:31–6. doi: 10.1007/s15010-013-0494-z 23821485

31. Higuera F, Rangel-Frausto MS, Rosenthal VD, Soto JM, Castañon J, Franco G, et al. Attributable cost and length of stay for patients with central venous catheter-associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect. Control Hosp. Epidemiol. 2007;28:31–5. doi: 10.1086/510812 17315338

32. Wisplinghoff H, Cornely OA, Moser S, Bethe U, Stützer H, Salzberger B, et al. Outcomes of nosocomial bloodstream infections in adult neutropenic patients: a prospective cohort and matched case-control study. Infect. Control Hosp. Epidemiol. 2003;24:905–11. doi: 10.1086/502158 14700405

33. Wilson MZ, Rafferty C, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am. J. Infect. Control. 2014;42:1157–60. doi: 10.1016/j.ajic.2014.07.025 25444262

34. Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable Cost and Length of Stay for Central Line-Associated Bloodstream Infections. Pediatrics. 2014;133:e1525–32. doi: 10.1542/peds.2013-3795 24799537

35. Puchter L, Chaberny IF, Schwab F, Vonberg R-P, Bange F-C, Ebadi E. Economic burden of nosocomial infections caused by vancomycin-resistant enterococci. Antimicrob. Resist. Infect. Control. 2018;7:1. doi: 10.1186/s13756-017-0291-z 29312658

36. National Healthcare Safety Network. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Bloodstream Infection) [accessed 03 June 2019].

37. Kato Y, Hagihara M, Kurumiya A, Takahashi T, Sakata M, Shibata Y, et al. Impact of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) on central line-associated bloodstream infections (CLABSIs) in department of hematology at single university hospital in Japan. J. Infect. Chemother. 2018;24:31–5. doi: 10.1016/j.jiac.2017.08.013 29066217

38. Metzger KE, Rucker Y, Callaghan M, Churchill M, Jovanovic BD, Zembower TR, et al. The burden of mucosal barrier injury laboratory-confirmed bloodstream infection among hematology, oncology, and stem cell transplant patients. Infect. Control Hosp. Epidemiol. 2015;36:119–24. doi: 10.1017/ice.2014.38 25632993

39. Apostolopolou E, Raftopoulos V, Terzis K, Pissaki K, Pagoni M, Delibasi S. Infection probability score, APACHE II and KARNOFSKY scoring systems as predictors of infection onset in haematology-oncology patients. J. Clin. Nurs. 2010;19:1560–8. doi: 10.1111/j.1365-2702.2009.03011.x 20384664

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