| Evidence classification method： |
According to the principles of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system, the quality of evidence is evaluated from high to very low to determine the strength of recommendations (see Tables 1 and 2).
Evidence Levels: The GRADE methodology assesses the quality of evidence based on five aspects: (1) risk of bias, (2) inconsistency of results, (3) indirect evidence, (4) imprecision of results, and (5) reporting bias. The criteria for GRADE assessment of evidence quality are shown in Table 1. High-quality evidence derived from RCTs may have its quality downgraded due to the downgrading factors listed in Table 1. Low-quality evidence derived from observational (non-randomized) studies may be upgraded due to the upgrading factors listed in Table 1. |
| Purpose of the guideline: |
In ICU patients with bloodstream infections, over 50% of bloodstream infections are associated with central venous catheters. Based on catheter days, the average incidence of CLABSI in ICU settings in our country is 1.5 per 1,000 catheter days, which is similar to or even slightly lower than the incidence rates reported in developed countries, ranging from 1.8 to 5.2 per 1,000 catheter days. The proportion of CLABSI among nosocomial infections remains significant in our country, and there are considerable differences in CLABSI incidence rates across different regions and hospital levels. Reducing the occurrence of CLABSI remains one of the pressing challenges to be addressed.
In our country, Gram-positive bacteria continue to be the main pathogens causing CLABSI, with Staphylococcus being the most common (27.07%), including coagulase-negative staphylococci, Staphylococcus aureus, and enterococci. Staphylococcus aureus may be related to contamination during emergency catheter placement. Meanwhile, infections caused by Gram-negative bacteria are also on the rise, with Enterobacteriaceae being the most prevalent (22.31%), along with Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. With the increasing use of broad-spectrum antibiotics, reports of infections caused by resistant bacteria, including vancomycin-resistant enterococci, methicillin-resistant coagulase-negative staphylococci, carbapenem-resistant Enterobacteriaceae, and carbapenem-resistant Acinetobacter baumannii, have also emerged. Additionally, fungal infections should not be overlooked, primarily caused by Candida species. Compared to non-Candida-related catheter-associated bloodstream infections, those caused by Candida increase the risk of mortality from CLABSI by nearly threefold. CLABSI increases the risk of sepsis by 4%-14% and the risk of death by 12%-25%. The length of hospital stay and hospitalization costs for CLABSI patients significantly increase, placing a substantial economic burden on the healthcare system.
In light of ongoing advancements in medical technology, changes in antibiotic resistance trends, and the emergence of new antimicrobial agents, the Critical Care Medicine Branch of the Chinese Medical Association has updated and revised the “Guidelines for the Prevention and Treatment of Intravascular Catheter-Related Infections (2007).” By integrating the latest evidence-based medical advances, a consensus opinion on the clinical prevention, diagnosis, and treatment of CLABSI has been achieved, aiming to provide ICU medical staff with best practices for central vascular catheter management and to realize the standardized clinical management of CLABSI. |
