Significantly higher burden of CLABSIs observed among patients with COVID-19
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The rate of central line-associated bloodstream infections among patients with COVID-19 significantly increased during COVID-19 patient surges, according to a recent study.
“During the early months of the pandemic, we quickly realized that hospitals all over the country were experiencing a significant and sudden rise in central line-associated blood stream infections (CLABSI),” Michael Ben-Aderet, MD, associate director of hospital epidemiology at Cedars-Sinai, told Healio. “Publications started coming out in late 2020 detailing these increases, including from the CDC, but it wasn’t clear what was the underlying cause, which patients were being affected, and what could be done to stop it.”
To assess the impact of COVID-19 on CLABSI rates and to help characterize the patients who developed a CLABSI, Ben-Aderet and colleagues performed a retrospective cohort analysis at an academic teaching hospital in urban Los Angeles.
According to the study, study participants included inpatients aged 18 years and older with CLABSI. CLABSI rates and patient characteristics were analyzed for two cohorts during the pandemic from March 2020 to August 2021 — patients with COVID-19 CLABSI and patients with non-COVID-19 CLABSI.
Overall, the study showed that the rate of COVID-19 CLABSI was significantly higher than non-COVID-19 CLABSI (4.75 per 1,000 catheter days vs. 0.63 per 1,000 catheter days; RR = 7.5; P < .0001), whereas no difference was observed between the non-COVID-19 CLABSI rate and historical control. The researchers found these patients with COVID-19 CLABSIs were older, had higher rates of diabetes, were more likely to have been admitted to an ICU during their admission (98% vs. 54%; P < .0001), were more likely to have been in an ICU at the time of the CLABSI diagnosis (89% vs 29%; P < .0001) and had a higher in-house mortality rate (49% vs. 21%; P = .0025).
Additionally, the study showed that patients with COVID-19 CLABSI were less likely to have femoral catheters or long-term lines attributed to the CLABSI, whereas arterial line use was more frequent in patients with COVID-19 CLABSI (89% vs 27%; P < .0001). Central-line use was also higher in the COVID-19 CLABSI cohort (0.66 vs 0.57; P < .0001), but the researchers did not detect a significant difference in median time to CLABSI from line insertion.
Candida species were more prevalent in COVID-19 CLABSIs (45%vs 23%; P = .0150), whereas gram-negative organisms were more prevalent in non-COVID-19 CLABSIs (27% vs. 11%; P = .0337).
"We did not detect a significant difference in rates of CLABSI with coagulase-negative Staphylococcus, Enterococcus, MRSA or polymicrobial CLABSI, but patients with COVID-19 CLABSI had a lower rate of MRSA," the researchers wrote.
“The main lesson is that patients admitted with critical illness from COVID-19 are at very high risk of CLABSI and should be the target of proactive CLABSI mitigation efforts,” Ben-Aderet said.
Unfortunately, he added, these infections happened during significant surges of patients with COVID-19, which Ben-Aderet said “strained the human resources” of the medical system and made large-scale quality improvement projects challenging.
“We were not able to see significant reductions in COVID-19 CLABSI with our interventions, despite very good success in reducing non-COVID-19 CLABSIs,” Ben-Aderet said.
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