Abstract
Central line-associated bloodstream infections (CLABSIs) remain a leading cause of preventable morbidity and mortality in intensive care units (ICUs), yet the timing of infection onset across different central line types has not been fully characterized. This study investigates the temporal dynamics of first-episode CLABSI among adult ICU patients, with a specific focus on comparing time-to-infection across internal jugular, subclavian, and femoral catheter placements. Using a dataset from hospitals in Mumbai, India, ICU admissions from 2020 to 2025, we evaluated central line catheter type, insertion site, dwell time, patient age, sex, comorbidity index, and ICU type as potential determinants of CLABSI risk.
Survival analysis of ICU patients with central line placement revealed significant variation in CLABSI-free survival across catheter types. PICC lines demonstrated the highest hazard for infection onset, while internal jugular lines showed the most favorable survival profile. Subclavian and femoral lines exhibited intermediate risk, though femoral catheters did not show the expected elevation in hazard. Age appeared modestly protective, potentially reflecting confounding by device selection or clinical complexity. Additional devices and prolonged peripheral catheter use were associated with increased CLABSI risk. Kaplan-Meier curves and Cox proportional hazards models were used to estimate time-to-infection and adjust for patient-level and procedural covariates, with stratified modeling employed to address non-proportional hazards.
Through this study, variation in time-to-CLABSI across line types highlights the need for device-specific prevention strategies, particularly for high-risk catheters such as PICCs. For future direction, expanding the number of cases for each central line type and implementing more flexible frameworks to approach the data such as landmarking and Fine-Gray modeling may better inform prevention guidelines and further reduce CLABSI rates across ICUs