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Published on: July 13, 2019
Risk factors for central line-associated bloodstream infection in pediatric intensive care units
Matthew C Wylie1, Dionne A Graham, Gail Potter-Bynoe
1From the Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. matthew.wylie@childrens.harvard.edu
Insights
Prolonged central venous catheter use, parenteral nutrition, and blood transfusions are key risk factors for central line-associated bloodstream infections (CLABSI) in children. New risk factors like gastrostomy tubes and cardiovascular disease were identified.
Area of Science:
- Pediatric Intensive Care Medicine
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
Background:
- Central line-associated bloodstream infections (CLABSI) are a significant concern in pediatric intensive care units (ICUs).
- Identifying specific risk factors is crucial for developing targeted prevention strategies.
Purpose of the Study:
- To identify risk factors for CLABSI in pediatric ICU patients.
- To describe patient subgroups who may benefit from adjunctive preventive interventions.
Main Methods:
- A case-control study was conducted in the medical-surgical and cardiac ICUs of a quaternary pediatric hospital.
- Patients with CLABSI (cases) were matched with patients with central venous catheters but without CLABSI (controls) based on ICU admission date.
- Multivariate conditional logistic regression was used to identify independent risk factors.
Main Results:
- Independent predictors of CLABSI included: prolonged central access (≥15 days), central venous catheter placement within the ICU, nonoperative cardiovascular disease, presence of a gastrostomy tube, parenteral nutrition, and blood transfusion.
- The predictive model achieved a positive predictive value of 54% and a negative predictive value of 79% for CLABSI.
Conclusions:
- Confirmed risk factors for pediatric CLABSI include duration of central access, parenteral nutrition, and blood transfusion.
- Newly identified risk factors include gastrostomy tube presence, nonoperative cardiovascular disease, and ICU placement of the central venous catheter.
- Children with these identified risk factors may be candidates for enhanced CLABSI prevention measures.
Objective:
We sought to identify risk factors for central line-associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions.
Design:
Case-control study of children admitted to the medical-surgical intensive care unit (ICU) or cardiac ICU from January 1, 2004, through December 31, 2007.
Setting:
Children's Hospital Boston is a freestanding, 396-bed quaternary care pediatric hospital with a 29-bed medical-surgical ICU and a 24-bed cardiac ICU.
Patients:
Case patients were patients with CLABSI who were identified by means of prospective surveillance. Control subjects were patients with a central venous catheter who were matched by ICU admission date.
Methods:
Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI and to derive and to validate a prediction rule.
Results:
Two hundred three case patients were matched with 406 control subjects. Independent predictors of CLABSI included duration of ICU central access (odds ratio [OR] for 15 or more days, 18.41 [95% confidence interval {CI}, 4.10-82.56]; P < .001), central venous catheter placement in the ICU (OR for 2 or more ICU-placed catheters, 8.63 [95% CI, 2.63-28.38]; P = .001), nonoperative cardiovascular disease (OR, 7.44 [95% CI, 2.13-25.98]; P = .012), presence of gastrostomy tube (OR, 3.48 [95% CI, 1.55-7.79]; P = .003), receipt of parenteral nutrition (OR, 3.12 [95% CI, 1.55-6.32]; P = .002), and receipt of blood transfusion (OR, 2.55 [95% CI, 1.21-5.36]; P = .014). By use of risk factors known before central venous catheter placement, our model predicted CLABSI with a positive predictive value of 54% and a negative predictive value of 79%.
Conclusions:
Duration of central access, receipt of parenteral nutrition, and receipt of blood transfusion were confirmed as risk factors for CLABSI among children in the ICU. Newly identified risk factors include presence of gastrostomy tube, nonoperative cardiovascular disease, and ICU placement of central venous catheter. Children with these risk factors may be candidates for adjunctive interventions for CLABSI prevention.
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