Bloodstream infections in pediatric oncology outpatients: a new healthcare systems challenge
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Theresa L Smith1, Gregg T Pullen, Vonda Crouse
1Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Pediatric hematology-oncology outpatients with transcutaneous central venous catheters (CVCs) face increased risk for bloodstream infections (BSIs), especially in summer. Proper CVC care and protection during water activities are crucial to prevent non-endogenous, gram-negative BSIs.
Area of Science:
- Infectious Diseases
- Pediatric Hematology-Oncology
- Medical Device Infections
Background:
- Central venous catheters (CVCs) are essential for pediatric hematology-oncology outpatients.
- A perceived increase in CVC-associated bloodstream infections (BSIs) prompted this investigation.
- Understanding risk factors is crucial for preventing infections in immunocompromised children.
Purpose of the Study:
- To investigate a perceived rise in CVC-associated bloodstream infections (BSIs) among pediatric hematology-oncology outpatients.
- To identify specific risk factors contributing to CVC-BSIs in this vulnerable population.
- To inform prevention strategies for CVC-related infections.
Main Methods:
- A case-control study was conducted at a pediatric hematology-oncology outpatient clinic.
- Case-patients had CVC-BSIs, while control-patients had CVCs without BSIs.
- Data collected included demographics, diagnoses, catheter type, care practices, and water exposure.
Main Results:
- No overall increase in CVC-associated BSI rates was found.
- A significant increase in non-endogenous, gram-negative BSIs occurred during summer months.
- Transcutaneous CVCs were more common in case-patients than control-patients.
- Water exposure was similar and high in both groups during summer.
Conclusions:
- Pediatric hematology-oncology patients with transcutaneous CVCs are at higher risk for BSIs, particularly in summer.
- Proper CVC care, especially during bathing and recreational water activities, is vital.
- Preventing non-endogenous, gram-negative BSIs requires targeted interventions and patient education.
Objective:
To investigate a perceived increase in central venous catheter (CVC)-associated bloodstream infections (BSIs) among pediatric hematology-oncology outpatients.
Design:
A case-control study.
Setting:
A pediatric hematology-oncology outpatient clinic at Fresno Children's Hospital.
Patients:
Pediatric hematology-oncology clinic outpatients with CVCs at Fresno Children's Hospital between November 1994 and October 1997.
Methods:
A case-patient was defined as any hematology-oncology outpatient with a CVC-associated BSI at Fresno Children's Hospital from November 1996 to October 1997 (study period) without a localizable infection. To identify case-patients, we reviewed Fresno Children's Hospital records for all hematology-oncology clinic patients, those with CVCs and those with CVCs and BSIs. Control-patients were randomly selected hematology-oncology outpatients with a CVC but no BSI during the study period. Case-patient and control-patient demographics, diagnoses, caretakers, catheter types, catheter care, and water exposure were compared.
Results:
Twenty-five case-patients had 42 CVC-associated BSIs during the study period. No significant increase in CVC-associated BSI rates occurred among pediatric hematology-oncology patients. However, there was a statistically significant increase in nonendogenous, gram-negative (eg, Pseudomonas species) BSIs during summer months (May-October) compared with the rest of the year. Case-patients and control-patients differed only in catheter type; case-patients were more likely than control-patients to have a transcutaneous CVC. Summertime recreational water exposures were similar and high in the two groups.
Conclusions:
Hematology-oncology clinic patients with transcutaneous CVCs are at greater risk for CVC-associated BSI, particularly during the summer. Caretakers should be instructed on proper care of CVCs, particularly protection of CVCs during bathing and recreational summer water activities, to reduce the risk of nonendogenous, gram-negative BSIs.
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