Predictive Factors for the Development of Central Line–Associated Bloodstream Infection Due to Gram-Negative Bacteria in Intensive Care Unit Patients After Surgery

摘要

Objectives. To examine the relative proportions of central line–associated bloodstream infection (BSI) due to gram-negative bacteria and due to gram-positive bacteria among patients who had undergone surgery and patients who had not. The study also evaluated clinical predictive factors and unadjusted outcomes associated with central line–associated BSI caused by gram-negative bacteria in the postoperative period.nnDesign. Observational, case-control study based on a retrospective review of medical records.nnSetting. University of Chicago Medical Center, a 500-bed tertiary care center located on Chicago's south side.nnPatients. Adult intensive care unit (ICU) patients who developed central line–associated BSI.nnResults. There were a total of 142 adult patients who met the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System definition for central line–associated BSI. Of those, 66 patients (46.5%) had infections due to gram-positive bacteria, 49 patients (34.5%) had infections due to gram-negative bacteria, 23 patients (16.2%) had infections due to yeast, and 4 patients (2.8%) had mixed infections. Patients who underwent surgery were more likely to develop central line–associated BSI due to gram-negative bacteria within 28 days of the surgery, compared with patients who had not had surgery recently (57.6% vs 27.3%; ). On multivariable logistic regression analysis, diabetes mellitus (adjusted odds ratio [OR], 4.6 [95% CI, 1.2-18.1]; ) and the presence of hypotension at the time of the first blood culture positive for a pathogen (adjusted OR, 9.8 [95% CI, 2.5-39.1]; ) were found to be independently predictive of central line–associated BSI caused by gram-negative bacteria. Unadjusted outcomes were not different in the group with BSI due to gram-negative pathogens, compared to the group with BSI due to gram-positive pathogens.nnConclusions. Clinicians caring for critically ill patients after surgery should be especially concerned about the possibility of central line–associated BSI caused by gram-negative pathogens. The presence of diabetes and hypotension appear to be significant associated factors.