Risk Factors of Catheter- Associated Bloodstream Infection: Systematic Review and Meta-Analysis
Elisabeth Lafuente Cabrero ,Roser Terradas Robledo, Anna Civit Cuñado, Diana García Sardelli, Carlota Hidalgo López, Dolors Giro Formatger, Laia Lacueva Perez, Cristina Esquinas López, Avelina Tortosa Moreno
Introduction: Catheter-associated bloodstream infections (CLABSI) pose a significant health problem, leading to increased mortality rates and economic costs. However, there is a lack of consensus regarding the risk factors for CLABSI due to the heterogeneous nature of published studies. This study aims to conduct a systematic review and meta-analysis to synthesize and identify the predisposing risk factors for CLABSI reported in the literature.
Introduction: The use of central venous catheters (CVCs) has become prevalent in medical practice, particularly in hospitalized patients. While CVCs offer numerous benefits in terms of safe medication administration and nursing care, they are also associated with CLABSI.
Materials and Methods: A meta-analysis was conducted to identify the most prevalent risk factors for CLABSI. The analysis included quantitative reviews of risk factors such as total parenteral nutrition (TPN), number of lumens, duration of catheter placement, chemotherapy, immunosuppression, kidney disease, and diabetes. Mean values and standard deviations were used to analyze the duration of catheterization, while odds ratios (OR) were calculated for qualitative factors. Heterogeneity among studies was assessed using the Cochrane-Q test and the I2 index. Pooled estimates were obtained using both fixed-effect and random-effect models.
Results: Out of the 23 studies included, 17 were eligible for the meta-analysis. The identified risk factors for CLABSI included TPN administration, multilumen catheters, duration of catheterization, chemotherapy, immunosuppression, kidney disease, and diabetes mellitus. Monolumen devices were associated with a lower probability of CLABSI. Six studies were excluded due to various reasons, such as inadequate risk factor definitions or measurements, lack of multiple studies analyzing the same risk factors, and nonsignificant results.
Discussion: Preventing CLABSI is challenging due to its severe clinical implications and the widespread use of venous devices in hospitals. The review findings highlight the importance of individual risk factor evaluation for CLABSI development. Well-designed studies with homogeneous patient samples are needed to enhance the quality of results and assess the efficacy and cost-effectiveness of therapeutic strategies.
Conclusion: The decision to use a venous device should be based on a comprehensive evaluation of risk factors for CLABSI, considering the potential severe clinical consequences and high healthcare costs. Further research is warranted to improve the quality of evidence and evaluate the effectiveness of devices and therapeutic interventions.
Acknowledgments: We acknowledge Donna Pringle for her assistance with language editing.
Citation: Lafuente Cabrero E, Terradas Robledo R, Civit Cuñado A, García Sardelli D, Hidalgo López C, Giro Formatger D, et al. (2023) Risk factors of catheter-associated bloodstream infection: Systematic review and meta-analysis. PLoS ONE 18(3): e0282290. https://doi.org/10.1371/journal.pone.0282290
Editor: Ahmet Murt, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, TURKEY
Received: November 30, 2021; Accepted: February 13, 2023; Published: March 23, 2023
Copyright: © 2023 Lafuente Cabrero et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting information files.
Funding: ELC received a research grant from Becton Dickinson S.A. The grant, reference MS-01702-2019-02-12/FIMIM 12773, was awarded to the doctoral thesis project of ELC through the Grupo de Investigación de Cuidados Enfermeros (GRECI) of the Instituto Municipal de Investigación Médica (IMIM). Becton Dickinson S.A had no role in the study design, data collection, analysis, manuscript preparation, or access to the study results until publication. The URL of Becton Dickinson S.A is: https://www.bd.com/es-es.
Competing interests: The authors have no conflict of interest.