Vascular access devices and hospital-onset bacteremia

"The type and number of VADs, particularly central and arterial lines, are associated with increased odds of HOB and higher in-hospital mortality. Infection prevention strategies should focus on minimizing unnecessary VADs and closely monitoring high-risk patients" Mielke et al (2026).

"The type and number of VADs, particularly central and arterial lines, are associated with increased odds of HOB and higher in-hospital mortality. Infection prevention strategies should focus on minimizing unnecessary VADs and closely monitoring high-risk patients" Mielke et al (2026).

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Vascular access devices and hospital-onset bacteremia

Abstract:

Background: Hospital-onset bacteremia (HOB) has emerged as a broader measure of bloodstream infections beyond CLABSI, capturing infections from all vascular access devices (VADs).

Objective: To evaluate the relationship between VADs and HOB in hospitalized adults.

Methods: We conducted a retrospective observational study of adult patients hospitalized within a 14-hospital system from January 1, 2022, to December 31, 2023. Adult patients with a VAD and blood cultures collected ≥48 hours after admission were included. HOB was defined as a positive blood culture with a non-commensal organism obtained ≥48 hours after admission and initiation of new antimicrobials within ±2 days of the blood culture date. Logistic regression models evaluated associations between VAD type, quantity, and HOB. Multivariable models controlled for age, length of stay, sex, and comorbid cancer.

Results: Among 3929 hospitalized adults, 279 (7.1%) developed HOB. Patients with HOB had a higher median number of VADs (5 vs 4, p < .001) and more frequently had central (54.5% vs 39.4%, p < .001) and arterial lines (10.9% vs 5.3%, p = .008). Central lines were associated with higher odds of HOB (aOR: 1.48, 95% CI: 1.15-1.91, p = .003), as were arterial lines (aOR: 1.45, 95% CI: 1.11-1.90, p = .008). Each additional VAD increased odds of HOB (aOR: 1.09, 95% CI: 1.01-1.18, p = .028). HOB was associated with higher in-hospital mortality (27.2% vs 16.0%, p < .001) with an adjusted OR of 1.81 (95% CI: 1.36-2.40, p < .001).

Conclusions: The type and number of VADs, particularly central and arterial lines, are associated with increased odds of HOB and higher in-hospital mortality. Infection prevention strategies should focus on minimizing unnecessary VADs and closely monitoring high-risk patients.

Reference:

Mielke N, Quimby D, Jizba T, Dilsaver DB, Nooney M, Respicio S, Vivekanandan R. Vascular access devices and hospital-onset bacteremia beyond CLABSI: An observational cohort study. J Infect Prev. 2026 Mar 16:17571774261434725. doi: 10.1177/17571774261434725. Epub ahead of print. PMID: 41853629; PMCID: PMC12992134.