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August 17, 2025Open Access

Central Line-Associated Bloodstream Infections in Intensive Care Unit During and After the COVID-19 Pandemic, 5-Year Prospective Observational Study

JSJakub SleziakWroclaw Medical University MBMarta BłażejewskaWroclaw Medical University WDWiesława DuszyńskaWroclaw Medical University

Key Points

Stable CLABSI incidence rates were observed, despite increased patient volume post-pandemic, implying effective infection prevention protocols.
Among 3149 ICU patients, the incidence density was 2.49 per 1000 central-vascular-catheter days, with Staphylococcus epidermidis being the most prevalent pathogen.
This retrospective analysis used prospectively collected data from January 2020 to December 2024, covering multiple ICU patient cases.
Findings highlight ongoing knowledge gaps in CLABSI epidemiology and emphasize the need for diligent infection control during future healthcare crises.

Abstract

Background/Objectives: The COVID-19 pandemic significantly disrupted healthcare systems worldwide, leading to increased healthcare-associated infection rates, particularly in the intensive care unit (ICU) setting. Little is known about the evolution of this phenomenon in subsequent years. Methods: This retrospective analysis of prospectively collected data (January 2020–December 2024) examined central line-associated bloodstream infections (CLABSI) in the Wroclaw Medical University hospital’s ICU during and after the COVID-19 pandemic. Results: Ninety CLABSI cases were observed in 3149 ICU patients across 39,837 patient-days and 36,038 central-vascular-catheter-days (CVC-D). The mean CLABSI frequency was 2.97 per 100 admissions, with an incidence density of 2.49 per 1000 CVC-D. CLABSI occurred more frequently in males than in females (3.51% vs. 1.69%, p = 0.003) and in patients with concomitant SARS-CoV-2 infection than in individuals without such coinfection (6.06% vs. 1.88%, p = 0.00037). Microbiological analysis revealed Staphylococcus epidermidis as the most frequent etiological factor of CLABSI (33.3%). Alert pathogens constituted 34.26% of all CLABSI etiological factors, with higher prevalence during the pandemic than afterward (51.16% vs. 23.08%, p = 0.005437). Patients with CLABSI had significantly longer ICU stays (53.57 vs. 11.62 days, p = 0.001). After adjusting for immortal time bias using matched cohort analysis, CLABSI was not associated with increased mortality (p = 0.735). The overall compliance level of adherence to CLABSI prevention measures was 86.9%, with no statistically significant difference between the pandemic and post-pandemic periods, p = 0.417. The study did not systematically collect data on catheter types, insertion sites, or clinical circumstances (emergency vs. elective), which are known risk factors that may have influenced the observed CLABSI incidence rates. Conclusions: Despite increased patient volume post-pandemic, CLABSI metrics remained stable, possibly due to the successful adaptation of infection prevention protocols. However, interpretation of incidence data should consider unmeasured confounding factors. These findings address knowledge gaps regarding how the pandemic affected CLABSI epidemiology and antimicrobial resistance patterns, with implications for infection control practices during future healthcare crises.

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