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Central-line associated bloodstream infections in a tertiary care children's University hospital: a prospective study
Elisabetta Venturini1, Carlotta Montagnani1, Alessandra Benni1
1Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
Insights
Central-line associated bloodstream infections (CLABSI) are common in children. This study found higher CLABSI rates in females and children with underlying conditions, highlighting the spread of multi-resistant pathogens.
Area of Science:
- Pediatric Infectious Diseases
- Healthcare Epidemiology
- Clinical Microbiology
Background:
- Central-line associated bloodstream infections (CLABSI) are the most frequent healthcare-associated infections in pediatric populations.
- There is a need for high-quality, large-scale studies on CLABSI in children, particularly in diverse healthcare settings.
- This prospective study addresses this gap by monitoring CLABSI across all departments of an Italian tertiary care children's hospital.
Purpose of the Study:
- To prospectively investigate the incidence and risk factors of central-line associated bloodstream infections (CLABSI) in children admitted to a tertiary care hospital.
- To identify specific patient demographics and underlying conditions associated with an increased risk of CLABSI.
- To characterize the microbial pathogens, including multi-resistant organisms, causing CLABSI in this pediatric cohort.
Main Methods:
- A 6-month prospective surveillance of CLABSI in all pediatric patients (<18 years) with central line access at Meyer Children's University Hospital, Florence, Italy.
- CLABSI cases were identified using the Centers for Disease Control and Prevention criteria.
- Incidence rates, relative risks, and confidence intervals were calculated, with statistical significance set at p < 0.05.
Main Results:
- The overall CLABSI incidence rate was 3.73 per 1000 central line-days (95% CI: 2.54-5.28).
- Higher CLABSI incidence was observed in female patients (p=0.045) and those with underlying medical conditions (p=0.06), excluding prematurity, surgical diseases, and malignancy.
- Five infections were caused by extended-spectrum β-lactamase (ESBL) producing organisms, and one by carbapenem-resistant Klebsiella pneumoniae.
Conclusions:
- The study confirms the increasing prevalence of multi-resistant pathogens causing healthcare-associated infections in children.
- Underlying medical conditions were identified as a significant factor associated with increased CLABSI rates in pediatric patients.
- Further pediatric research is recommended to better understand CLABSI risk factors and develop targeted intervention strategies.
Background:
The central-line associated bloodstream infections (CLABSI) are the most common healthcare-associated infections in childhood. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. The present survey is the first prospective study monitoring for 6 months the occurrence of central-line associated bloodstream infections in all departments of an Italian tertiary care children's university hospital.
Methods:
The study involved all children aged less than 18 years admitted to Meyer Children's University Hospital, Florence, Italy who had a central line access between the October 15th, 2014 and the April 14th, 2015. CLABSI were defined according to the Center for Disease Control and Prevention criteria. CLABSI incidence rates with 95% confidence limits were calculated and stratified for the study variables. For each factor the relative risk and 95% confidence intervals were evaluated. Statistical analysis was performed using the statistical software SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL), p < 0.05 was considered statistically significant.
Results:
CLABSI rate was 3.73/1000 (95% CI: 2.54-5.28) central line-days. A higher CLABSI incidence was seen with female gender (p = 0.045) and underlying medical conditions (excepting prematurity, surgical diseases and malignancy) (p = 0.06). In our study 5 infections, were caused by extended-spectrum β-lactamase producing organisms and in one case by carbapenem-resistant Klebsiella pneumoniae.
Conclusions:
Our study confirms the spreading of multi-resistant pathogens as causes of healthcare associated infections in children. An increased incidence rate of CLABSI in our study was related to underlying medical conditions. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas.
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