# P-1045. Death by CLABSI?

## TL;DR

The study suggests that some bloodstream infections in critically ill patients near death may be due to gut bacteria rather than catheter infections, which could affect hospital infection reporting.

## Contribution

The study introduces evidence that gut translocation may lead to misclassification of CLABSIs in end-of-life patients.

## Key findings

- MBI organisms accounted for more bloodstream infections in patients who died compared to survivors.
- CLABSIs within a week of death were more often caused by MBI organisms.
- Findings suggest CLABSIs may result from gut translocation, not catheter infections.

## Abstract

Central line-associated bloodstream infections (CLABSIs) are hospital-acquired infections tied to quality metrics and penalties, but their validity near the end of life is unclear. We hypothesized that critically ill patients experience gut translocation of mucosal barrier injury (MBI) organisms, leading to bloodstream infections misclassified as CLABSIs. We evaluated the microbiology near death to assess the impact of gut translocation on reporting.Figure 1Figure 2

A retrospective review of 191 adult inpatients with mucosal barrier injury (MBI) and non-MBI CLABSIs at University of Iowa Hospitals and Clinics (2021–2025) was conducted using National Healthcare Safety Network (NHSN) surveillance definitions. Patients were divided into survival and death groups, and blood culture data were analyzed relative to the time of death. Organisms were classified as MBI or non-MBI per NHSN criteria.Table 1

Of 191 patients, 48 (25%) died during admission, with 11 patients dying before the blood culture had resulted. Relative to the survival group, MBI organisms accounted for a greater proportion of bloodstream infections (68.0% vs. 58.0%, Figure 1). In the death group, CLABSIs occurring within 1 week of death were more often caused by MBI organisms (73.5%, Figure 2). Organism-specific analysis is shown in Table 1.

Data demonstrates that MBI organisms are more frequently isolated as patients near death, suggesting that CLABSIs may result from gut translocation rather than true catheter infections. These findings warrant review of CLABSI surveillance definitions near the end of life to improve reporting accuracy.

Philip M. Polgreen, MD, Eli Lily: Advisor/Consultant|Pfizer: Grant/Research Support