Risk factors associated with mortality in patients with catheter-related and catheter-associated bloodstream infections: a retrospective observational study focused on CVADs and midlines

Background: Vascular access devices (VADs) are essential in healthcare but carry risks, including bloodstream infections and increased mortality. This study aimed to identify risk factors for in-hospital all-cause mortality in non-ICU patients with CVADs and midlines and for infection-related mortality in patients with catheter-related/associated bloodstream infections (CRBSI/CABSI). Methods: We conducted a retrospective, single-center study at an Italian tertiary hospital, enrolling hospitalized non-ICU patients with VADs (CVADs and midlines in particular) between July 2021 and March 2024. We analyzed demographic, clinical, VAD, and microbiological data. Risk factors for mortality were assessed using competing risk models. Results: Among 2062 patients with CVADs or midlines, in-hospital all-cause mortality was 13.9% (4.41 deaths/1000 patient-days). Independent risk factors included advanced age (HR: 1.05 per year), > 4 comorbidities (HR: 1.55), COVID-19-related pneumonia (HR: 2.58), and cachexia (HR: 2.59). Female sex (HR: 0.71) and multiple VAD placements (HR: 0.54) were protective. Among 159 CRBSI/CABSI patients, infection-related mortality was 12.6% (5.24 deaths/1000 patient-days). Prompt catheter removal (HR: 0.09) and appropriate antibiotic therapy (HR: 0.37) were independently protective. Coagulase-negative Staphylococci were less frequent in CRBSI/CABSI deaths (25% vs. 53.7%). Conclusion: Mortality in non-ICU patients with CVAD or midlines is significantly influenced by age, comorbidity burden, and COVID-19 related pneumonia. For CRBSI/CABSI, timely catheter removal and appropriate antibiotics are crucial for improving survival. These findings underscore the importance of targeted risk assessment and aggressive management strategies in this vulnerable population.