Amanda J. Naylor

IMPORTANCE: The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source. OBJECTIVES: We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018–2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH. Each CLABSI episode was assessed for relationship with central venous catheter (CVC), suspected secondary source of BSI, mortality associated with the CLABSI hospital encounter, and availability of infectious disease physician or primary physician documentation of infectious source. MAIN OUTCOMES AND MEASURES: CLABSI episodes were classified as CVC related, CVC unrelated, and CVC relationship unclear. Mortality during the same encounter as the CLABSI event was assessed as an outcome measure. Descriptive statistics were performed. RESULTS: A total of 340 CLABSI episodes occurred in adult patients in VBP units. Majority of the CLABSI, 77.5% (266), occurred in the ICU. Of the CLABSI analyzed, 31.5% (107) were classified as unrelated to the CVC; 25.0% (85) had an unclear source; 43% (148) were classified as CVC related. For CVC-related cases, Staphylococcus and Candida were the predominant organisms. For the CVC unrelated and unclear groups Enterococcus was most prevalent. The mortality rate was lowest among patients classified with a CVC-related BSI. The positive predictive value (PPV) of the Centers for Disease Control and Prevention CLABSI definition to predict a true CVC-related infection was found to be 58.0%. CONCLUSIONS AND RELEVANCE: The definition of CLABSI as a surrogate for catheter-related BSI is inadequate, with a PPV of 58.0% (43.1–67.6%). Efforts should be redirected toward revising the CLABSI definition and possibly reevaluating its criteria. Resources should be assigned to further investigate and systematically prevent BSIs from secondary sources while adhering to existing CLABSI prevention bundles.

Introduction: The purpose of this study was to compare the short- to mid-term outcomes of patients who underwent reverse total shoulder arthroplasty (RTSA) for severe glenohumeral osteoarthritis (GHOA) with an intact rotator cuff (RC) to a matched rotator cuff arthropathy (RCA) cohort. Methods: Between 2004 and 2014, all patients who underwent RTSA for severe GHOA with a minimum 2-year follow-up were identified. Demographic and baseline variables were extracted from the medical records. Subjects were matched in the ratio of 1:2 to RTSA subjects with RCA, while controlling for the demographic and intraoperative variables. Postoperative active forward elevation (AFE), active external rotation, American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Scale (VAS), and Simple Shoulder Test were recorded. Complications and revision surgery rates were noted. Comparative multivariate analysis was performed. Preoperative Walch classification for each subject was obtained through radiograph review, and the impact of classification was assessed using one-way analysis of variance testing. Results: One hundred thirty-six patients were available with mean follow-up 32.3 ± 12.3 months. Baseline range of motion and patient reported outcome scores were similar between the groups (P > 0.05), except for Simple Shoulder Test (intact rotator cuff: 5.7 ± 7.4 versus RCA: 2.4 ± 1.8, P = 0.037). The intact RC group had significantly, superior absolute outcome measures for active external rotation (P = 0.006), and SST (P = 0.048), but not for SANE (P = 0.055), VAS (P = 0.464), ASES (P = 0.084), and AFE (P = 0.099). No notable difference was observed between the groups for improvement in motion, survey scores, or complications. Walch osteoarthritis classification did not impact the outcome measurements in the severe GHOA with the intact RC group (P > 0.05). Discussion: Patients who underwent RTSA for severe GHOA with intact RC demonstrate similar consistent improvement in outcomes to demographically similar patients with RCA. The severity of GHOA defined by the Walch classification did not impact the outcomes at the 2-year follow-up. Level of Evidence: Level III Therapeutic Study.

BACKGROUND: Continuous blood pressure monitoring may facilitate early detection and prompt treatment of hypotension. We tested the hypothesis that area under the curve (AUC) mean arterial pressure (MAP) P = .006). The result was robust over an as-treated analysis and for sensitivity analyses with thresholds of 60 and 70 mm Hg. CONCLUSIONS: Intraoperative blood pressure monitoring with arterial catheters detected nearly twice as much hypotension as oscillometric measurements.