Incidence and factors associated with central line-associated bloodstream infection in patients with chronic intestinal failure. A 20-year retrolective cohort.

Abstract

Type 3 Intestinal Failure (IF-3) is a chronic condition in which patients may require long-term Outpatient Intravenous Supplementation (OIS) to maintain hydration and nutrition, they are susceptible to catheter-related infectious complications. The present study aimed to determine the incidence of factors associated with central line-associated bloodstream infection (CLABSI) in patients with IF-3 on OIS. Retrolective cohort study of patients with IF-3 undergoing OIS treated at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a national tertiary care and referral center in Mexico City, between 2004 and 2024. Sociodemographic, anthropometric, biochemical, clinical, and microbiological data, including isolated pathogens, were collected. Variables associated with CLABSI incidence were determined using Poisson regression analysis. Sixty patients were included, of which 31 (51.7%) were female and 29 (48.3%) were male. The mean age was 49.5 ± 18.1 years, and BMI was 19.8 ± 5.31 kg/m2. The primary pathophysiological mechanism of IF-3 was short bowel syndrome (n = 23 (38.3%)). Twenty-seven (45%) patients developed CLABSI, resulting in 36 events over 27,200 catheter days, with an incidence rate of 1.323 per 1,000 catheter days. Fifty-seven pathogens were isolated, the most frequent being Gram-negative bacteria (52.6%), specifically the Enterobacter cloacae complex (23.3%) and Klebsiella oxytoca (16.6%). Patients with intestinal stomas had a higher incidence of CLABSI (74% vs 48.4%; p = 0.039). Depression (IR 1.43; 95% CI 1.04-1.97, p = 0.028) was associated with a higher incidence of CLABSI. The incidence rate of CLABSI was lower than reported in other studies in upper-middle-income countries. Depression and the presence of intestinal stomas may be associated with a higher risk of CLABSI, possibly through their impact on self-care and stress-inflammation pathways. These results underscore the importance of psychosocial and clinical factors in preventing CLABSI. Multicentre studies are needed to enhance external validity across diverse settings.