Central Line-Associated Bloodstream Infection (CLABSI): Causes, Pathogenesis, Risk Factors, Diagnosis, Treatment and Prevention

Introduction to CLABSI
Epidemiology and Incidence of CLABSI in Healthcare Settings
Causes and Pathogenesis of CLABSI
Risk Factors for CLABSI
CLABSI Common Pathogens
Clinical Features of CLABSI
CLABSI Diagnosis
Management and Treatments of CLABSI
Complications and Outcomes of CLABSI
Prevention and infection control strategies for CLABSI
Advantages of Prevention Bundles and Limitations in CLABSI Control
Guidelines and Protocols for CLABSI Prevention (CDC, WHO)
Conclusion
References

Introduction to Central line-associated bloodstream infection (CLABSI)

Central line-associated bloodstream infection (CLABSI) is a serious and potentially life-threatening healthcare-associated infection (HAI) that can occur in patients with a central venous catheter (central line).
For surveillance purposes, a CLABSI is defined as a bloodstream infection in a patient who:

Has a central line in place at the time of infection, or
Had a central line in place within the 48 hours before the onset of the infection.

A CLABSI is identified when a recognized pathogen is recovered from a blood culture and the infection meets the established surveillance criteria.
CLABSI is primarily a surveillance definition, rather than a definitive clinical diagnosis. It is used by public health organizations, including the Centers for Disease Control and Prevention (CDC), to monitor and compare central line-associated infection rates within healthcare institutions.
CLABSI should be distinguished from catheter-related bloodstream infection (CRBSI), which is a more specific clinical diagnosis.
In CRBSI, definitive laboratory evidence is required to demonstrate that the central venous catheter itself is the source of the bloodstream infection. This may involve microbiological evidence from the catheter hub, catheter tip, or paired blood cultures demonstrating a relationship between the catheter and the bloodstream infection.
In contrast, a CLABSI does not require definitive laboratory proof that the catheter is the direct source of the bloodstream infection.
For a bloodstream infection to meet the CLABSI surveillance definition, it must be considered a primary bloodstream infection, with no other identifiable secondary source of infection elsewhere in the body.
Therefore, the key distinction is:

CLABSI: A surveillance-based definition used to monitor healthcare-associated bloodstream infections in patients with recent central line exposure.
CRBSI: A clinical diagnosis requiring evidence that specifically establishes the catheter as the source of the bloodstream infection.

Epidemiology and Incidence of Central Line-Associated Bloodstream Infection (CLABSI) in Healthcare Settings

The epidemiology of central line-associated bloodstream infection (CLABSI) varies considerably depending on the healthcare setting, available resources, infection prevention practices, and socioeconomic conditions.
In high-income countries, the implementation of strict infection prevention and quality improvement measures has contributed to relatively low CLABSI rates, generally ranging from approximately 0.5 to 2.2 infections per 1,000 catheter-days.
In contrast, low- and middle-income countries (LMICs) experience a substantially higher burden of CLABSI, particularly in resource-constrained healthcare facilities. Reported incidence densities in these settings range from approximately 3.5 to 17.04 infections per 1,000 catheter-days.
Hospital intensive care units (ICUs) generally have the highest incidence of CLABSI. This includes:

Neonatal ICUs (NICUs)
Pediatric ICUs (PICUs)
Adult medical ICUs
Adult surgical ICUs

The increased risk in ICUs is associated with several factors, including:

Frequent and prolonged use of central venous catheters.
A high number of invasive procedures.
Emergency catheterization, which may provide limited opportunity for optimal aseptic technique.
Use of multilumen central lines, which provide multiple access points and may increase opportunities for microbial contamination.
Critically ill patients who often require prolonged vascular access and intensive medical interventions.

Before the COVID-19 pandemic, CLABSI rates had generally shown a declining trend in many healthcare systems over approximately a decade, largely due to improvements in central-line insertion practices, catheter maintenance, surveillance, and infection prevention programs.
The COVID-19 pandemic significantly disrupted these infection prevention efforts and was associated with substantial increases in CLABSI rates in many healthcare settings.
Several factors contributed to the increased CLABSI burden during the pandemic, including:

Overextended healthcare staff and increased patient-to-staff ratios.
Increased workload and clinical demands in ICUs.
Changes or interruptions in routine catheter maintenance practices.
Altered frequency of catheter assessment and dressing changes.
Increased use of central lines in critically ill patients requiring prolonged intensive care.

Overall, CLABSI remains an important healthcare-associated infection, with the greatest burden often occurring in intensive care and resource-limited settings. Differences in infection rates between countries and healthcare facilities highlight the importance of standardized surveillance, evidence-based catheter practices, adequate staffing, and effective infection prevention and control (IPC) programs.

Causes and Pathogenesis of Central Line-Associated Bloodstream Infection (CLABSI)

The pathogenesis of central line-associated bloodstream infection (CLABSI) begins with the colonization of an intravascular catheter by microorganisms, which can subsequently gain direct access to the bloodstream.

Extraluminal migration: This route is more commonly observed during the first 7–10 days after catheter placement. Microorganisms from the patient's skin flora at the catheter insertion site migrate along the external surface of the catheter and through the catheter track, eventually reaching the bloodstream.
Intraluminal contamination: This pathway is more frequently associated with long-term central lines, particularly those remaining in place for more than 10 days. Microorganisms enter the catheter lumen through injection hubs, injection ports, or contaminated connections. Contamination may occur during catheter manipulation and is often associated with inadequate hand hygiene or aseptic technique by healthcare workers.
Hematogenous seeding: Microorganisms originating from a distant site of infection may enter the bloodstream and subsequently attach to and colonize the surface of the central catheter. In this situation, the catheter becomes secondarily colonized by microorganisms already circulating in the patient's blood.
Infusate contamination: Occasionally, intravenous fluids, medications, or total parenteral nutrition (TPN) may become contaminated during manufacturing, preparation, storage, or administration. Contaminated infusates can introduce microorganisms directly into the bloodstream through the central line.

Overall, these pathways allow microorganisms to colonize the catheter, establish biofilms on its surface, and enter the bloodstream, ultimately contributing to the development of CLABSI.

Risk Factors for Central Line-Associated Bloodstream Infection (CLABSI)

The risk of central line-associated bloodstream infection (CLABSI) is influenced by both device- and procedure-related factors and patient-related factors.

Anatomical site: The femoral vein is associated with a higher risk of catheter colonization and infection because of its proximity to skin folds and perineal flora. The internal jugular vein has an intermediate risk, whereas the subclavian vein is generally associated with the lowest risk of infection.
Catheter duration: The risk of infection generally increases with the duration of central line placement, particularly when the catheter remains in place longer than clinically necessary.
Number of lumens: Multi-lumen catheters increase the number of access points and require more frequent hub manipulation. This creates additional opportunities for microbial contamination compared with single-lumen catheters.
Urgency of insertion: Central lines inserted during emergency situations or bedside resuscitation may have a higher infection risk because full aseptic precautions, including maximum sterile barrier precautions, may be difficult to maintain.
Underlying chronic diseases: Conditions such as diabetes mellitus, chronic kidney disease (CKD), and severe malnutrition can compromise normal tissue integrity and immune defenses, increasing susceptibility to infection.
Impaired immune status: Severe neutropenia, active malignancies, and immunosuppressive medications can significantly weaken the body's ability to eliminate invading microorganisms and increase the risk of bloodstream infection.
Infusate type: Total parenteral nutrition (TPN) and lipid-containing formulations can support the growth of certain microorganisms and are particularly associated with an increased risk of infection caused by Candida and other fungi.

Central Line-Associated Bloodstream Infection (CLABSI) Common Pathogens

The microorganisms responsible for central line-associated bloodstream infection (CLABSI) include Gram-positive bacteria, Gram-negative bacteria, and fungi. The distribution of causative organisms varies according to local antimicrobial resistance patterns, healthcare practices, patient populations, and regional epidemiology.

Gram-positive cocci: Common organisms include Staphylococcus epidermidis and other coagulase-negative staphylococci (CoNS), Staphylococcus aureus, and Enterococcus spp. These organisms are among the most frequently reported causes of CLABSI and are strongly associated with skin flora migration and biofilm formation on catheter surfaces.
Gram-negative bacilli: Important pathogens include Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli. These organisms are particularly important in resource-limited healthcare settings and ICUs in low- and middle-income countries (LMICs), where they may exhibit multidrug-resistant (MDR) phenotypes, making treatment more challenging.
Fungi: Important fungal pathogens include Candida albicans, Candida parapsilosis, and non-albicans Candida species. Candida bloodstream infections are particularly associated with patients receiving long-term total parenteral nutrition (TPN), prolonged broad-spectrum antibiotic therapy, or intensive immunosuppressive treatment.

The ability of many CLABSI pathogens to form biofilms on catheter surfaces is an important factor in persistent colonization and infection because biofilms can protect microorganisms from host immune responses and reduce their susceptibility to antimicrobial therapy.

Overall, the local microbiological profile and antimicrobial resistance patterns should be considered when selecting empirical therapy for suspected CLABSI, with treatment subsequently guided by blood culture results and antimicrobial susceptibility testing.

Clinical Features of Central Line-Associated Bloodstream Infection (CLABSI)

The clinical presentation of central line-associated bloodstream infection (CLABSI) can range from subtle or nonspecific symptoms to severe systemic infection, including sepsis and septic shock.

Fever and chills: A common clinical presentation is the sudden onset of fever accompanied by rigors or chills, particularly when there is no obvious alternative source of infection.
Fever may be absent: Older adults and immunocompromised patients may not develop a typical fever despite having a serious bloodstream infection.
Hypothermia: An abnormally low body temperature may occur, particularly in patients with severe systemic infection.
Tachypnea: Unexplained or sudden rapid breathing may indicate systemic infection and developing sepsis.
Altered mental status: New-onset confusion, reduced alertness, or other changes in mental status may occur as the infection progresses or when systemic perfusion is impaired.
Hypotension: Sudden, unexplained low blood pressure may be a sign of severe systemic infection and can indicate progression toward septic shock.
Local catheter-site signs: The central line exit site should be examined for evidence of local inflammation or infection, including:

Erythema: Redness around the catheter insertion site.
Induration: Abnormal firmness or hardening of the surrounding tissue.
Warmth: Increased local skin temperature.
Tenderness: Pain or discomfort at the catheter site.
Purulent drainage: Pus or other purulent material emerging from the catheter exit site.

Absence of local signs does not exclude CLABSI: The catheter insertion or exit site may appear completely normal even when the central line is the source of a bloodstream infection. Therefore, the absence of redness, swelling, tenderness, or drainage at the catheter site does not rule out CLABSI, particularly when systemic signs of infection are present.

Central Line-Associated Bloodstream Infection (CLABSI) Diagnosis

Accurate diagnosis of central line-associated bloodstream infection (CLABSI) requires a combination of clinical assessment, appropriate blood culture collection, and precise microbiological testing. The results must meet the established surveillance criteria before the infection can be classified as CLABSI.
A primary bloodstream infection (BSI) is identified when one or more blood cultures are positive for a recognized bacterial or fungal pathogen, provided that the infection does not meet the criteria for a secondary bloodstream infection originating from another site.
When the isolated organism is a common skin commensal, such as coagulase-negative staphylococci (CoNS), additional evidence is required because these organisms may represent contamination during blood sample collection. In such cases, the organism should be recovered from two or more independently collected blood cultures obtained on separate occasions.
To determine whether the central catheter is the likely source of the bloodstream infection, clinicians may collect paired blood cultures from:

A peripheral vein
The central venous catheter (CVC) hub

Equal volumes of blood should be collected from the peripheral vein and catheter and inoculated into appropriate blood culture bottles. Comparing the time required for each culture to become positive can help determine whether the catheter is the likely source.
Differential time to positivity (DTP) is an important diagnostic approach. If the blood culture collected through the catheter becomes positive at least 2 hours earlier than the simultaneously collected peripheral blood culture, this strongly supports the catheter as the source of the bloodstream infection.
The earlier positivity of the catheter-drawn culture reflects the possibility of a higher microbial burden within the catheter, resulting in faster detection of the organism compared with the peripheral blood culture.
Importantly, CLABSI and catheter-related bloodstream infection (CRBSI) are not synonymous. CLABSI is primarily a surveillance definition, whereas CRBSI requires clinical and microbiological evidence specifically linking the bloodstream infection to the catheter.

Management and Treatments of Central Line-Associated Bloodstream Infection (CLABSI)

Management of central line-associated bloodstream infection (CLABSI) should begin promptly once infection is suspected. Appropriate blood cultures should be obtained before starting antimicrobial therapy whenever this can be done without delaying treatment, and antimicrobial selection should be guided by the patient's clinical condition, suspected pathogens, and local antimicrobial resistance patterns.
Empirical antimicrobial therapy: Initial treatment should provide adequate coverage against both Gram-positive and Gram-negative organisms. The choice of empirical antibiotics should be guided by the patient's severity of illness, risk factors for antimicrobial resistance, previous microbiological results, and the local antibiogram.
Gram-positive coverage: Intravenous vancomycin is commonly used as empirical therapy when infection with methicillin-resistant Staphylococcus aureus (MRSA) or other resistant Gram-positive organisms, including coagulase-negative staphylococci (CoNS), is suspected. Alternative agents may be considered based on susceptibility results and patient-specific factors.
Gram-negative coverage: Broad-spectrum antibiotics with antipseudomonal activity, such as cefepime or piperacillin-tazobactam, may be used for Gram-negative coverage. A carbapenem such as meropenem may be considered when there is a high risk of resistant Gram-negative organisms, particularly in critically ill or neutropenic patients.
Antifungal therapy: Empirical antifungal treatment with an echinocandin, such as caspofungin, may be considered in patients at high risk for candidemia, including those receiving long-term total parenteral nutrition (TPN), patients with profound immunosuppression, or those exposed to prolonged broad-spectrum antimicrobial therapy.
Targeted antimicrobial therapy: Once blood cultures identify the causative microorganism and antimicrobial susceptibility testing is available, empirical treatment should be narrowed to the most appropriate targeted agent. This de-escalation of therapy helps minimize unnecessary antimicrobial exposure and reduce the risk of antimicrobial resistance.
Catheter removal: Catheter removal should be strongly considered when CLABSI is complicated, when the causative organism has a high potential for complications or biofilm formation, or when source control cannot otherwise be achieved.
Catheter removal is generally indicated in situations such as:

Severe sepsis, hemodynamic instability, or septic shock
Persistent bacteremia or fungemia, particularly when blood cultures remain positive despite appropriate antimicrobial therapy
Infection caused by organisms for which catheter salvage is generally unsuccessful or associated with a high risk of complications, including Staphylococcus aureus, Pseudomonas aeruginosa, Candida species, and certain Bacillus or mycobacterial infections
Evidence of metastatic or secondary complications such as infective endocarditis or septic thrombophlebitis
Evidence that the catheter is infected and cannot be safely retained or effectively sterilized

Catheter retention and antibiotic lock therapy: In carefully selected cases of uncomplicated CLABSI, particularly infections caused by less virulent organisms such as coagulase-negative staphylococci, catheter salvage may be considered when vascular access is extremely limited or catheter replacement presents substantial procedural or mechanical risks.
Antibiotic lock therapy (ALT): When catheter retention is attempted, systemic antimicrobial therapy may be supplemented with antibiotic lock therapy. ALT involves instilling a highly concentrated antimicrobial solution into the catheter lumen while the catheter is not being used. The solution remains in the lumen for a specified dwell period and is subsequently withdrawn or flushed according to the treatment protocol.
The high local antimicrobial concentration achieved with antibiotic lock therapy is intended to act against microorganisms residing within the catheter lumen and biofilm, while systemic antimicrobial therapy treats the bloodstream infection.
The decision to retain or remove a central line should be individualized according to the causative organism, severity of infection, presence of complications, catheter type, duration of catheterization, availability of alternative vascular access, and clinical response to therapy.

Complications and Outcomes of Central Line-Associated Bloodstream Infection (CLABSI)

If central line-associated bloodstream infection (CLABSI) is not recognized and treated promptly, it can progress from a localized catheter-related infection to severe systemic complications, resulting in prolonged hospitalization, increased healthcare costs, and potentially death.
Infective endocarditis: Microorganisms associated with the catheter may persist within a biofilm matrix, enter the bloodstream, and seed the cardiac valves. Infective endocarditis may require prolonged intravenous antimicrobial therapy and, in severe cases, surgical valve repair or replacement.
Septic thrombophlebitis: Infection may lead to the formation of an infected thrombus within the vein, often near the catheter tip or along the catheterized vessel. The infected thrombus can serve as a persistent source of microorganisms entering the bloodstream and may make infection difficult to eradicate.
Metastatic infections: Hematogenous dissemination of microorganisms can result in infection at distant sites, including osteomyelitis, septic arthritis, and splenic or hepatic abscesses.
Sepsis and septic shock: A CLABSI can progress to systemic inflammatory response, sepsis, and potentially septic shock, particularly in critically ill or immunocompromised patients.
Increased healthcare costs: CLABSI can substantially increase healthcare expenditure because of prolonged hospitalization, additional diagnostic testing, antimicrobial treatment, intensive care, and management of complications.
Death: Severe CLABSI, particularly when associated with sepsis, septic shock, or metastatic infection, can be life-threatening and may result in death.

Prevention and infection control strategies for Central Line-Associated Bloodstream Infection (CLABSI)

Because many central line-associated bloodstream infections (CLABSIs) are preventable, healthcare facilities rely on standardized infection prevention and control (IPC) practices covering both central line insertion and ongoing catheter maintenance.
Hand hygiene: Perform thorough hand hygiene with soap and water or an appropriate alcohol-based hand rub before handling the catheter, insertion site, hubs, or any component of the central line.
Maximal sterile barrier precautions: During catheter insertion, the healthcare provider should use a sterile gown, sterile gloves, cap, and mask, while the patient should be covered with a full-body sterile drape to minimize microbial contamination.
Skin antisepsis: Prepare the catheter insertion site using an appropriate chlorhexidine-based antiseptic, such as 2% chlorhexidine gluconate in 70% isopropyl alcohol, when not contraindicated. The antiseptic should be allowed to air-dry completely before catheter insertion.
Site selection: For non-tunneled central venous catheters in adults, the subclavian site is generally preferred over the internal jugular or femoral site when clinically appropriate because it is associated with a lower risk of catheter-related infection. Site selection should also consider other complications, particularly the risk of mechanical complications.
Hub and port disinfection: Before every catheter access, thoroughly disinfect the catheter hub, needleless connector, or injection port using an appropriate antiseptic and adequate mechanical friction. Allow the antiseptic to dry according to the manufacturer's instructions before accessing the line.
Daily medical-necessity review: The need for the central line should be assessed every day by the clinical team. The catheter should be promptly removed as soon as it is no longer medically necessary, since unnecessary prolongation of catheterization increases the opportunity for infection.
Ongoing catheter maintenance: Catheter dressings, connections, and access points should be routinely assessed for contamination, damage, loosening, or signs of infection. Proper aseptic technique should be maintained whenever the catheter is manipulated.
Consistent adherence to evidence-based insertion and maintenance practices, combined with regular surveillance and staff education, is essential for reducing CLABSI rates and improving patient outcomes.

Advantages of Prevention Bundles and Limitations in CLABSI Control

Advantages of Prevention Bundles in CLABSI Control

Improved compliance and accountability: Standardized insertion and maintenance bundles allow healthcare facilities to monitor compliance through checklists, audits, and routine tracking. This promotes accountability and consistent adherence to infection prevention practices.
Reduction in infection rates: Consistent implementation of evidence-based prevention bundles can significantly reduce CLABSI rates, even in complex critical care environments where patients frequently require prolonged central venous access.
Standardization of clinical practice: Prevention bundles provide healthcare workers with a consistent approach to central line insertion and maintenance, reducing variation in clinical practice and strengthening the institutional culture of infection prevention and patient safety.

Limitations of CLABSI Control Strategies

Sustainability and compliance fatigue: Maintaining very high compliance with multiple checklist-based practices over extended periods can lead to clinician fatigue and reduced adherence. Compliance may decline during severe staff shortages, increased workloads, or major healthcare crises.
High-risk patient populations: Certain patient groups remain at increased risk of CLABSI despite appropriate adherence to prevention bundles. These include extremely low-birth-weight neonates and pediatric oncology patients who require long-term indwelling vascular lines.
Persistent infection risk: Underlying disease, prolonged catheterization, frequent line access, and repeated catheter manipulation can contribute to persistent infection risk in these high-risk populations, even when standard prevention measures are followed correctly.
Need for adjunctive strategies: Prevention bundles cannot eliminate CLABSI risk in every patient. Selected high-risk cases may require additional evidence-based interventions, such as antimicrobial lock therapy, alongside continued surveillance and individualized catheter management.
Overall, prevention bundles provide an effective foundation for CLABSI prevention, but their long-term effectiveness depends on sustained compliance, adequate staffing, continuous monitoring, and additional strategies for patients with particularly high infection risk.

Guidelines and Protocols for CLABSI Prevention (CDC, WHO)

International organizations, including the Centers for Disease Control and Prevention (CDC), the Healthcare Infection Control Practices Advisory Committee (HICPAC), and the World Health Organization (WHO), recommend structured and standardized approaches to central line-associated bloodstream infection (CLABSI) prevention and surveillance.
CDC/NHSN surveillance protocol: The CDC National Healthcare Safety Network (NHSN) provides standardized definitions and surveillance methods for monitoring CLABSI rates and evaluating institutional infection prevention performance.
Standardized Infection Ratio (SIR): The NHSN uses the Standardized Infection Ratio (SIR) as a risk-adjusted measure that allows healthcare facilities to compare observed CLABSI events with predicted numbers of infections. This supports institutional benchmarking and assessment of infection prevention performance.
Chlorhexidine-impregnated dressings: Updated infection prevention recommendations support the use of chlorhexidine-impregnated dressings for appropriate central venous catheters in adult and pediatric patients, as an additional measure to reduce microbial colonization and bloodstream infection risk.
Hub and connector disinfection: Healthcare facilities should implement strict protocols for disinfecting catheter hubs and needleless connectors before every access. Specialized disinfection caps, where appropriate and supported by institutional protocols, can provide an additional approach to maintaining connector asepsis.
Staff education and competency: All healthcare professionals responsible for central line insertion or maintenance should receive structured education and undergo regular competency assessment to ensure correct application of aseptic technique and catheter-care practices.
Institutional oversight: Effective CLABSI prevention requires continuous institutional monitoring, including surveillance, compliance auditing, staff training, feedback of infection data, and implementation of corrective measures when gaps in practice are identified.
Overall, adherence to evidence-based recommendations from organizations such as the CDC, HICPAC, WHO, SHEA, and IDSA, combined with standardized surveillance and ongoing staff competency assessment, provides a comprehensive framework for reducing CLABSI risk in healthcare settings.

Conclusion

Central line-associated bloodstream infections (CLABSIs) remain a significant and costly threat to patient safety, particularly in critical care settings where central venous catheters are frequently required.
The development of CLABSI is strongly influenced by microbial colonization and biofilm formation on indwelling catheter surfaces, which can protect microorganisms from host immune responses and antimicrobial treatment.
Despite these challenges, a substantial proportion of CLABSIs are preventable through consistent implementation of evidence-based infection prevention and control practices.
Effective prevention depends on strict adherence to central line insertion and maintenance bundles, appropriate catheter-site care, proper hub disinfection, regular assessment of catheter necessity, and prompt removal of unnecessary central lines.
Patients at particularly high risk may require additional, individualized prevention strategies, including antimicrobial lock therapy in carefully selected situations where catheter salvage is appropriate.
Ultimately, reducing CLABSI rates requires a combination of standardized protocols, continuous surveillance, staff education and competency assessment, sustained compliance, and timely catheter removal. These measures are essential for improving patient outcomes, reducing healthcare-associated costs, and protecting vulnerable patient populations.

References

El-Sokkary, R., Negm, E., ElNaser, F., Soliman, A., Afifi, A., Morsi, S., Abdel-Kareem, A., Eladl, A., Ibrahim, M., Abdeldayem, M., & Malek, M. (2025). Central venous catheter care and the healthcare–environment interface: Outcomes of a quality improvement initiative in a resource-constrained ICU. Frontiers in Public Health, 13, 1713370. https://doi.org/10.3389/fpubh.2025.1713370
Ghimire, R. (2025). Predictors of central line-associated bloodstream infections (CLABSI) among patients admitted to the intensive care unit of a tertiary care center. Journal of General Medicine of Nepal, 199–204. https://doi.org/10.3126/jgmc-n.v18i2.85869
Haddadin, Y. (2022). Central line-associated bloodstream infections. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430891
L’Etoile, N., Li, Y., Hayes, E., & Coffin, S. E. (2026). Antimicrobial locks for the prevention of central line-associated bloodstream infections in pediatric patients: A systematic review and network meta-analysis. Antimicrobial Resistance & Infection Control, 15(1), 34. https://doi.org/10.1186/s13756-026-01704-z
Rajandra, A., Yunos, N. M., Teo, C. H., Kukreja, A., Suhaimi, N. A., Razali, S. Z. M., Basri, S., Ju Teh, C. S., Leong, C. L., Ismail, I., Azmel, A., Yunus, N. H. M., Rajahram, G. S., Ismail, A. J., Deva, S. R., Kee, P. W., The Working Group, & Ponnampalavanar, S. S. L. S. (2025). Incidence, compliance, and risk factors associated with central line-associated bloodstream infection (CLABSI) in intensive care unit (ICU) patients: A multicenter study in an upper middle-income country. Antibiotics, 14(3), 271. https://doi.org/10.3390/antibiotics14030271
Rhodes, K. A., & Youree, B. (2025). A multidisciplinary approach to reducing central line-associated bloodstream infections (CLABSI). Open Forum Infectious Diseases, 12(1).* https://doi.org/10.1093/ofid/ofae631.432
Sheet, N. F. (2026). National Healthcare Safety Network (NHSN) overview. Centers for Disease Control and Prevention. https://www.cdc.gov/nhsn/pdfs/pscmanual/1psc_overviewcurrent.pdf
Sleziak, J., Blazejewska, M., & Duszynska, W. (2025). Central line-associated bloodstream infections in intensive care unit during and after the COVID-19 pandemic: 5-year prospective observational study. Journal of Clinical Medicine, 14(16), 5655. https://doi.org/10.3390/jcm14165655
Verma, P., Gupta, S., Bansal, S., & Pandey, G. P. (2026). Surveillance of central-line-associated bloodstream infections (CLABSI) in intensive care units of a tertiary care center in Western India. GMS Hygiene and Infection Control. https://doi.org/10.3205/dgkh000618