The CONSIDER study: Assessing the risk of catheter-associated bloodstream infections beyond the intensive care setting

Background: Catheter-associated and related bloodstream infection (CABSI and CRBSI) are major causes of hospital-acquired infections. However, their incidence and risk factors in non-intensive care unit (ICU) patients with vascular access devices (VADs) remain unclear. Methods: This retrospective study evaluated CABSI and CRBSI incidence and risk factors in non-ICU hospitalized adults with VADs. Hazard ratios (HR) were estimated with gamma frailty models and random survival forest analysis. Key variables were identified and validated in multivariable models. Results: Among 2,326 VAD insertions (1,892 patients), 153 with CRBSI or CABSI were identified. The incidence was 1.80 per 1,000 catheter-days for CABSI, 1.24 for CRBSI, and 2.97 overall. Coagulase-negative Staphylococci were the most isolated pathogens (43.9%). Infections were associated with parenteral nutrition (PN) (HR = 4.12) and multilumen catheters (HR = 2.56). Random survival forest models identified PN, intravenous drug use, and in-patient regimen as top variables. CRBSI was strongly associated with PN (HR = 7.42), while CABSI was linked to intravenous drug use (HR = 7.20). Conclusions: Our study showed a high incidence of CABSI and CRBSI in non-ICU adult patients. Identifying risk factors highlights the settings where stringent infection prevention strategies are needed.