Publication: Survival time and prognostic factors of mortality among patients with catheter-related bloodstream infection at Hospital Pakar Universiti Sains Malaysia
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Date
2025-08
Authors
Hamidi, Nor Aini
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Abstract
Introduction: Catheter-related bloodstream infection (CRBSI) is considered as one of the most frequently reported healthcare-associated infections (HCAIs) in the healthcare settings. This serious yet preventable infection is associated with high morbidity and mortality rate. To date, the local and global data on median survival time and survival rate of CRBSI is limited. Objective: This study aimed to determine the survival time and prognostic factors that influence the mortality of patients with CRBSI. Methodology: This study was a single-centre retrospective study which involving 181 patients with CRBSI at Hospital Pakar USM from 2018 until 2022. Data collected for this study included patient-related factors, catheter-related factors, clinical-related factors, and organism-related factors. The outcome variable of this study was the survival time. The primary event referred to all-cause mortality of CRBSI patients within 90 days after onset, while censored observation referred to the patient who was still alive at the end of study, did not experience event or lost to follow up. Kaplan Meier estimate and life table analysis were used to determine median survival time and survival rate. Cox regression analysis was performed to determine the significant prognostic factors of mortality. Results: In total, the number of patients who died due to CRBSI and other related causes within 90 days after onset was 35.4%. The median survival time could not be determined by the Kaplan-Meier curve due to a high survival among CRBSI patients which may be related to early diagnosis and effective treatment in this centre. The one-, three- and six- month survival rate were 77.4% (95% CI: 70.5, 82.8), 65.2% (95% CI: 57.8, 71.6), and 64.6% (95% CI: 57.2, 71.1) respectively. The prognostic factors that significantly affect survival of CRBSI patients were sepsis or septic shock (aHR: 5.95; 95% CI: 2.88, 12.28), mechanical ventilation (aHR: 5.94; 95% CI: 3.29, 10.71), shorter length of hospital stay (aHR: 1.13; 95% CI: 1.10, 1.17), female gender (aHR: 2.71; 95% CI: 1.60, 4.58), and infection with Gram-negative organism, which was linked to lower mortality risk (aHR: 0.31; 95% CI: 0.18, 0.55). Conclusions: Multiple Cox proportional hazards regression showed that sepsis or septic shock, use of mechanical ventilation, shorter hospital stay, female gender, and infection with Gram-negative organism (associated with a lower risk of death) were significant prognostic factors of mortality among patients with CRBSI. These findings provide a greater understanding of CRBSI outcomes which can assist physicians in the clinical decision making and CRBSI management.