Risk factors of central catheter bloodstream infections in intensive care units: A systematic review and meta-analysis

Background: Central catheter bloodstream infections (CRBSI) is a major cause of healthcare-associated infections. However, few factors are generally accepted and some studies have conflicting finding about some factors, possibly caused by limitation associated with an individual study. This study was to identify risk factors for CRBSI in intensive care units. Methods: We searched the PubMed, Cochrane Library, Web of science and EMBASE databases and the 4 top Chinese-language databases, including WanFang data, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Journal Database (VIP), China Biology Medicine disc (CBM) as of July 2023. Case control and cohort studies were included. Two authors independently screened the literature and evaluated the quality of the studies using the Newcastle-Ottawa scale (NOS). The pooled effect size was estimated using the odds ratio (OR), and the corresponding 95% confidence interval (CI) was calculated. The Cochrane Q (χ2) and I2 tests were used to assess heterogeneity among studies, and each risk factor was tested for its robustness using fixed- or random-effects models. Findings: A total of 32 studies enrolled, among which eleven factors were identified, they were divided into two categories: modifiable and unmodifiable factors. Modifiable factors: duration of catheterization (≥ 5d) (OR: 2.07, 95%CI: 1.41–3.03), duration of catheterization (≥ 7d) (OR: 3.62, 95%CI: 2.65–4.97), duration of catheterization (≥ 14d)(OR: 4.85, 95%CI: 3.35–7.01), total parenteral nutrition (OR: 2.27,95%CI: 1.56–3.29), use of multiple-lumen catheters(OR: 3.41, 95%CI: 2.27–5.11), times of tube indwelling (OR: 3.50, 95%CI: 2.93–4.17), length of ICU stay (OR: 4.05, 95%CI: 2.41–6.80), the position of indwelling(OR: 2.41, 95%CI: 2.03–2.85); Unmodifiable factors: APACHEII scores (OR: 1.84, 95%CI: 1.54–2.20), Age≥ 60 years old (OR: 2.19, 95%CI: 1.76–2.73), the extensive use of antibiotic (OR: 3.54, 95%CI: 1.65–7.61), Diabetes mellitus (OR: 3.06, 95%CI: 2.56–3.66), Immunosuppression (OR: 2.87, 95%CI: 2.08–3.95). Conclusions: Effective interventions targeting the above modifiable factors may reduce the risk of developing CRBSI in ICU and improve the clinical outcome of patients. Further prospective studies are needed to confirm these findings.