(1264) Racial and Ethnic Disparities in Central Line-Associated Bloodstream Infections: A Multicenter Study

Introduction: Racial and ethnic differences in central line-associated bloodstream infections (CLABSI) have been documented in various studies. The risk of CLABSI is influenced by patient-level factors, but most previous reports lack detailed data to adjust for potential confounders. The primary objective of this study was to compare the risk and exposure-adjusted CLABSI rates based on patient-reported race and ethnicity in all network hospitals of OSF HealthCare in Peoria, IL.

Methods: Data were extracted for all patients with central lines from 01/2018 to 06/2023 across 15 network hospitals, limited to patients' first admission only. Generalized Poisson regression was used, with the count of CLABSI and the log of catheter days as an offset, to examine the impact of race/ethnicity on CLABSI while controlling for confounding variables that could impact CLABSI risk. A random intercept was included to account for hospital-level clustering. Race and ethnicity were categorized as Hispanic, non-Hispanic (NH) White, NH Black, and NH Others.

Results: 23,133 patients (27,674 central lines, 245,889 catheter days) met the eligibility criteria, with a median age of 64 years. Among these patients, 1,918 (8.3%) were under 18 years old, 17,619 (76%) were NH White, 3,967 (17.1%) were NH Black, 1,006 (4.3%) were Hispanic, and 541 (2.3%) NH Others. There were 263 reported CLABSI cases, resulting in a CLABSI rate of 1.07 per 1,000 catheter days (Adults:0.931/1,000-line days, Pediatric:1.92/1,000 line days). Hispanic patients had higher CLABSI rates compared to NH White patients after controlling for all included confounding variables (Incidence Rate Ratio [IRR] 1.70, 95% CI 1.07-2.70, p = 0.024). No significantly higher risk was observed for NH Black patients (IRR 1.04, 95% CI 0.72-1.50, p = 0.85). Other independent significant factors for CLABSI risk included obesity (IRR 1.57), ICU admission (IRR 2.0), use of TPN (IRR 1.44), any blood product administration (IRR 2.24), and immunodeficiency (IRR 2.31). Age, insurance, sex, diabetes, dialysis, antineoplastic therapy, and cancer diagnosis were not associated with CLABSI in the adjusted analysis.

Conclusions: Even after adjusting for patient-level risk factors, racial differences in CLABSI risk persist, with Hispanic patients being more likely to develop CLABSI.