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Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit
Matthew F Niedner1, W Charles Huskins, Elizabeth Colantuoni
1Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA. mniedner@med.umich.edu
Insights
Central line-associated bloodstream infection (CLA-BSI) incidence in pediatric intensive care units (PICUs) decreased with a revised definition. Risk increased after 7 days, particularly for gastrointestinal and oncologic diagnoses.
Area of Science:
- Infectious Diseases
- Pediatric Critical Care
- Healthcare Epidemiology
Background:
- Central line-associated bloodstream infections (CLA-BSIs) are a significant concern in pediatric intensive care units (PICUs).
- Accurate epidemiological data are crucial for developing effective prevention strategies.
Purpose of the Study:
- To describe the epidemiology of CLA-BSIs in PICUs.
- To identify risk factors associated with CLA-BSI development.
Main Methods:
- A descriptive and cohort study was conducted across 29 and 18 PICUs, respectively, within a national improvement collaborative.
- Patients admitted between October 2006 and December 2007 with central lines were included.
- CLA-BSIs were identified using the National Healthcare Safety Network definition and re-adjudicated with the revised 2008 definition. Cox proportional hazards models were used to analyze risk factors.
Main Results:
- The CLA-BSI incidence was 3.1 per 1,000 central line-days, decreasing by 17% after readjudication with the revised definition (2.0 per 1,000 central line-days).
- Ninety-nine percent of patients remained CLA-BSI-free for the first 7 days; thereafter, the daily risk doubled to 0.27%.
- Higher CLA-BSI risk was observed in patients with gastrointestinal (HR, 2.7) and oncologic (HR, 2.6) diagnoses compared to respiratory diagnoses. Central line insertion in the jugular vein was associated with lower risk (HR, 0.43).
Conclusions:
- The revised 2008 CLA-BSI definition reduced the measured incidence.
- The risk of CLA-BSI is low during the initial 7 days of catheterization but increases significantly afterward.
- Patients with gastrointestinal and oncologic diagnoses, and those without jugular vein central lines, represent target populations for further research and intervention to reduce CLA-BSI rates.
Objective:
Describe central line-associated bloodstream infection (CLA-BSI) epidemiology in pediatric intensive care units (PICUs).
Design:
Descriptive study (29 PICUs); cohort study (18 PICUs).
Setting:
PICUs in a national improvement collaborative.
Patients/Participants:
Patients admitted October 2006 to December 2007 with 1 or more central lines.
Methods:
CLA-BSIs were prospectively identified using the National Healthcare Safety Network definition and then readjudicated using the revised 2008 definition. Risk factors for CLA-BSI were examined using age-adjusted, time-varying Cox proportional hazards models.
Results:
In the descriptive study, the CLA-BSI incidence was 3.1/1,000 central line-days; readjudication with the revised definition resulted in a 17% decrease. In the cohort study, the readjudicated incidence was 2.0/1,000 central line-days. Ninety-nine percent of patients were CLA-BSI-free through day 7, after which the daily risk of CLA-BSI doubled to 0.27% per day. Compared with patients with respiratory diagnoses (most prevalent category), CLA-BSI risk was higher in patients with gastrointestinal diagnoses (hazard ratio [HR], 2.7 [95% confidence interval {CI}, 1.43-5.16]; P < .002 ) and oncologic diagnoses (HR, 2.6 [CI, 1.06-6.45]; P = .037). Among all patients, including those with more than 1 central line, CLA-BSI risk was lower among patients with a central line inserted in the jugular vein (HR, 0.43 [CI, 0.30-0.95]; [P < .03).
Conclusions:
The 2008 CLA-BSI definition change decreased the measured incidence. The daily CLA-BSI risk was very low in patients during the first 7 days of catheterization but doubled thereafter. The risk of CLA-BSI was lower in patients with lines inserted in the jugular vein and higher in patients with gastrointestinal and oncologic diagnoses. These patients are target populations for additional study and intervention.
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