Electronic health record-derived care-exposure burden and central line-associated bloodstream infection among critically ill adults

Background: Central line-associated bloodstream infection (CLABSI) remains a clinically important healthcare-associated infection in intensive care units. Routinely collected electronic health record (EHR) data may capture patient-level care-process complexity not reflected by conventional catheter-related variables alone. Objective: To examine whether an EHR-derived care-exposure burden score was associated with adjudicated CLABSI or CLABSI-like bloodstream infection among critically ill adults with central venous catheter exposure. Methods: This multi-source retrospective cohort study used harmonised data from MIMIC-IV, the eICU Collaborative Research Database, and a Chinese real-world critical care cohort. Adult patients with documented central venous catheter exposure and an ascertainable post-catheterisation observation window were included. The primary care-exposure burden score summarised cumulative care-process complexity using charting frequency, unique caregivers, concurrent vascular lines, catheter duration, pre-insertion mechanical ventilation duration, antibiotic-type count, and 24-h fluid input and output after catheterisation. Components were log-transformed, robustly standardised within each data source, averaged into a composite score, and categorised into database-specific quartiles. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). A 48-h landmark-compatible sensitivity analysis recalculated the score after excluding total catheter duration. Results: < 0.001]. In the primary clinically adjusted model, higher burden quartiles showed progressively greater odds compared with Q1: Q2 aOR 1.46, Q3 aOR 2.51, and Q4 aOR 4.99. The association was attenuated but persisted in the landmark-compatible analysis excluding total catheter duration. Conclusion: Higher EHR-derived care-exposure burden was associated with higher odds of adjudicated CLABSI or CLABSI-like bloodstream infection. The score should be interpreted as a pragmatic patient-level marker of cumulative care complexity and infection-prevention prioritisation, rather than as a causal measure of care quality or nursing performance. Prospective validation is required before clinical implementation

Bloodstream infection · Central venous catheter · Cohort · Cohort study · Confidence interval · Logistic regression · Odds ratio · Quartile · Retrospective cohort study · Central Venous Catheters and Hemodialysis · Nosocomial Infections in ICU · Surgical site infection prevention

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