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Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit
John M Costello1, Dionne A Graham, Debra Forbes Morrow
1Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. john.costello@cardio.chboston.org
Insights
Unscheduled admissions, noncardiac conditions, and prolonged central line use increase central line-associated bloodstream infection (BSI) risk in pediatric cardiac intensive care units. Specific therapies also elevate BSI risk in these vulnerable patients.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Cardiovascular medicine
Background:
- Central line-associated bloodstream infections (CLABSIs) are a significant concern in pediatric cardiac intensive care units (CICUs).
- Identifying specific risk factors is crucial for developing targeted prevention strategies.
Purpose of the Study:
- To determine independent risk factors for CLABSI in patients within a pediatric CICU.
- To investigate risk factors specific to patients who have undergone cardiac surgery.
Main Methods:
- A matched case-control study was conducted in a pediatric CICU.
- Cases of CLABSI were identified, and two randomly selected controls with central vascular catheters were matched to each case.
- Univariate and multivariate conditional logistic regression analyses were employed to identify risk factors.
Main Results:
- Independent risk factors for CLABSI included nonelective medical admission, noncardiac comorbidities, low initial absolute neutrophil count, blood product exposure (≥3 units), prolonged central line use (≥7 days), and hydrocortisone use.
- In patients who underwent cardiac surgery, risk factors included low admission weight (≤5 kg), high Pediatric Risk of Mortality III score (≥15), significant blood product exposure (≥3 units), and prolonged mechanical ventilation (≥7 days).
Conclusions:
- Unscheduled medical admissions, noncardiac comorbidities, extended central line utilization, and certain medical therapies are significant independent risk factors for CLABSI in pediatric CICU patients.
- These findings highlight the need for vigilant monitoring and tailored preventive measures in this high-risk population.
Objective:
To identify risk factors for central line-associated bloodstream infection (BSI) in patients receiving care in a pediatric cardiac intensive care unit.
Design:
Matched case-control study.
Setting:
CICU at Children's Hospital Boston.
Patients:
Central line-associated BSI cases were identified between April 2004 and December 2006. We identified two randomly selected control patients who had a central vascular catheter and were admitted within 7 days of each index case.
Measurements And Main Results:
Univariate and multivariate conditional logistic regression analyses were used to identify risk factors for central line-associated BSI. In a secondary analysis, risk factors for central line-associated BSI in those cases who underwent cardiac surgery were sought. During the study period, 67 central line-associated BSIs occurred in 61 patients. Independent risk factors for central line-associated BSI were nonelective admission for medical management (odds ratio [OR] = 6.51 [1.58-26.78]), the presence of noncardiac comorbidities (OR = 4.95 [1.49-16.49]), initial absolute neutrophil count <5000 cells/uL (OR = 6.17 [1.39-27.48]), blood product exposure > or =3 units (OR = 5.56 [1.35-22.87]), central line days > or =7 (OR = 6.06 [1.65-21.83]), and use of hydrocortisone (OR = 28.94 [2.55-330.37]). In those patients who underwent cardiac surgery (n = 37 cases and 108 controls), independent risk factors for central line-associated BSI were admission weight < or =5 kg (OR = 3.13 [1.01-9.68]), Pediatric Risk of Mortality III score > or =15 (OR = 3.44 [1.19-9.92]), blood product exposure > or =3 units (OR = 3.38 [1.28-11.76]), and mechanical ventilation for > or =7 days (OR = 4.06 [1.33-12.40]).
Conclusions:
Unscheduled medical admissions, presence of noncardiac comorbidities, extended device utilization, and specific medical therapies are independent risk factors for central line-associated BSI in patients receiving care in a pediatric cardiac intensive care unit.
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