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Background <p>Mucosal barrier injury–laboratory confirmed bloodstream infections (MBI-LCBIs) represent a subset of central line–associated bloodstream infections (CLABSIs) that meet surveillance criteria for an endogenous origin, particularly in immunocompromised patients. Misclassification of these infections as conventional CLABSIs may distort surveillance metrics and misguide infection prevention strategies. This study aimed to estimate the pooled proportion of MBI-LCBIs among CLABSIs and explore sources of epidemiological variability.</p> Methods <p>A PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD420261281159) was conducted searching MEDLINE and EMBASE for literature published between January 2013 and April 2026. Observational studies reporting extractable data on MBI-LCBIs (per NHSN criteria) among total CLABSIs were included. A random-effects meta-analysis with restricted maximum likelihood (REML) estimation utilizing logit transformation was performed to pool proportions. Given the anticipated clinical and methodological diversity across included cohorts, pooled estimates were considered exploratory; heterogeneity was quantified using the I² statistic and Cochran’s Q test, and 95% prediction intervals (PI) were prioritized over point estimates to better characterize the expected range of true effects across clinical settings. A post-hoc univariate meta-regression assessed study sample size as a moderator of heterogeneity. To address potential small-study effects, a sensitivity analysis excluding studies with fewer than 200 participants was performed to derive a more conservative adjusted estimate. Predefined subgroup analyses evaluated patient age (pediatric vs. adult) and geographic region.</p> Results <p>Twenty-six studies encompassing an aggregate population of 44,759 patients were included. The exploratory pooled proportion of MBI-LCBI among CLABSIs was 39.2% (95% CI: 30.0%–49.3%), with extreme heterogeneity observed (I² = 99.4%). The 95% prediction interval ranged widely from 7.5% to 83.8%, indicating substantial variability across different clinical environments. Meta-regression demonstrated study size as a significant moderator; a sensitivity analysis excluding smaller, highly specialized cohorts (&lt; 200 participants) yielded a more conservative adjusted estimate of 30.3% (95% CI: 18.4%–45.4%). Pediatric cohorts demonstrated a comparable exploratory pooled burden (39.2%), while geographic region accounted for modest overall heterogeneity.</p> Conclusions <p>MBI-LCBIs constitute a clinically substantial but highly context-dependent proportion of CLABSIs. Given the extreme heterogeneity—driven largely by the concentration of highly immunosuppressed patients in specialized clinical settings—these pooled estimates must be interpreted with caution. Accurate differentiation of MBI-LCBIs from conventional CLABSIs is essential for equitable hospital benchmarking, targeted empiric antimicrobial stewardship, and feasible line-salvage strategies.</p>

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Burden of MBI-LCBI Among Central Line Associated Bloodstream Infections: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Yash Ranga,
  • Cheryl Jain,
  • Aayush Anand,
  • Venkata Peddi,
  • Ritesh Aggarwal,
  • Abhishek Ranga,
  • Pranathi Reddy Jetti,
  • Riddhi Agarwal,
  • Bharti Chura,
  • Aditya Kataria

摘要

Background

Mucosal barrier injury–laboratory confirmed bloodstream infections (MBI-LCBIs) represent a subset of central line–associated bloodstream infections (CLABSIs) that meet surveillance criteria for an endogenous origin, particularly in immunocompromised patients. Misclassification of these infections as conventional CLABSIs may distort surveillance metrics and misguide infection prevention strategies. This study aimed to estimate the pooled proportion of MBI-LCBIs among CLABSIs and explore sources of epidemiological variability.

Methods

A PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD420261281159) was conducted searching MEDLINE and EMBASE for literature published between January 2013 and April 2026. Observational studies reporting extractable data on MBI-LCBIs (per NHSN criteria) among total CLABSIs were included. A random-effects meta-analysis with restricted maximum likelihood (REML) estimation utilizing logit transformation was performed to pool proportions. Given the anticipated clinical and methodological diversity across included cohorts, pooled estimates were considered exploratory; heterogeneity was quantified using the I² statistic and Cochran’s Q test, and 95% prediction intervals (PI) were prioritized over point estimates to better characterize the expected range of true effects across clinical settings. A post-hoc univariate meta-regression assessed study sample size as a moderator of heterogeneity. To address potential small-study effects, a sensitivity analysis excluding studies with fewer than 200 participants was performed to derive a more conservative adjusted estimate. Predefined subgroup analyses evaluated patient age (pediatric vs. adult) and geographic region.

Results

Twenty-six studies encompassing an aggregate population of 44,759 patients were included. The exploratory pooled proportion of MBI-LCBI among CLABSIs was 39.2% (95% CI: 30.0%–49.3%), with extreme heterogeneity observed (I² = 99.4%). The 95% prediction interval ranged widely from 7.5% to 83.8%, indicating substantial variability across different clinical environments. Meta-regression demonstrated study size as a significant moderator; a sensitivity analysis excluding smaller, highly specialized cohorts (< 200 participants) yielded a more conservative adjusted estimate of 30.3% (95% CI: 18.4%–45.4%). Pediatric cohorts demonstrated a comparable exploratory pooled burden (39.2%), while geographic region accounted for modest overall heterogeneity.

Conclusions

MBI-LCBIs constitute a clinically substantial but highly context-dependent proportion of CLABSIs. Given the extreme heterogeneity—driven largely by the concentration of highly immunosuppressed patients in specialized clinical settings—these pooled estimates must be interpreted with caution. Accurate differentiation of MBI-LCBIs from conventional CLABSIs is essential for equitable hospital benchmarking, targeted empiric antimicrobial stewardship, and feasible line-salvage strategies.