Abstract:
Background: Hospital-attributable central line-associated bloodstream infections (HA-CLABSI) are associated with severe patient outcomes. Published data on HA-CLABSI epidemiology in hospitals locally remains limited. This study aimed to determine the HA-CLABSI incidence and risk factors to inform targeted infection prevention practices.
Methods: Retrospective, nested case-control study was performed at Singapore General Hospital from January 2018 to December 2020, involving 127 cases and 252 controls. HA-CLABSI cases developed CLABSI ≥ 3 calendar days of hospitalization. Controls had central line inserted but did not develop CLABSI. Cases and controls were matched on 1:2 ratio for central line insertion date. Multivariable conditional logistic regression was performed to identify independent risk factors for HA-CLABSI, with adjusted odds ratio (aOR), 95% confidence intervals (CI) and p-values reported. Variables with p-value < 0.05 were statistically significant. HA-CLABSI incidence rate was calculated per 1,000 central line-days.
Results: HA-CLABSI incidence rate during the study period was 8.4/1,000 central line-days. Independent risk factors for HA-CLABSI were transfer to high-risk areas (aOR: 2.03, 95% CI: 1.05-3.92), immunocompromised health status (aOR: 4.62, 95% CI: 2.20-9.69), antibiotic administration (aOR: 7.41, 95% CI: 3.24-16.92), and total parenteral nutrition (aOR: 3.61, 95% CI: 1.49-8.77) being included as indications for central line insertion, insertion of PICC (aOR: 13.61, 95% CI: 3.12-55.53), presence of non-tunneled central lines (aOR: 2.95, 95% CI: 1.48-5.87) and prior MRSA acquisition (aOR: 3.41, 95% CI: 1.83-6.35).
Conclusion: HA-CLABSI remains a significant concern despite on-going infection prevention efforts. Risk factors identified facilitate development of targeted, evidence-based interventions.
Reference:Arora S, Jin P, Myat Oo A, Aung MK, Conceicao EP, Yang Y, Sim JXY, How MKB, Bin Sazali I, Lee LC, Venkatachalam I, Ling ML. Incidence and risk factors for hospital-attributable central line-associated bloodstream infections in adult inpatients in a tertiary hospital. Antimicrob Steward Healthc Epidemiol. 2026 Jan 29;6(1):e27. doi: 10.1017/ash.2025.10149. PMID: 41625130; PMCID: PMC12854876.