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A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric
Aditya H Gaur1, David G Bundy2, Eric J Werner3
11St Jude Children's Research Hospital,Memphis,Tennessee.
Insights
Tracking all bloodstream infections (BSIs) in pediatric hematology-oncology (PHO) patients, not just central line-associated BSIs (CLABSIs), provides a clearer picture of infection burden. This comprehensive approach aids in understanding and reducing infection rates across healthcare centers.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Pediatric Oncology
Background:
- Bloodstream infections (BSIs) pose a significant threat to pediatric hematology-oncology (PHO) inpatients.
- Current tracking methods may not fully capture the BSI burden in this vulnerable population.
Purpose of the Study:
- To assess the overall burden of BSIs in PHO inpatients.
- To propose and evaluate a comprehensive, all-BSI tracking strategy.
- To inform comparisons of infection rates within and across healthcare centers.
Main Methods:
- A prospective cohort study was conducted across 34 US PHO centers.
- Infections were categorized using National Healthcare Safety Network (NHSN) definitions, including CLABSI (stratified), secondary BSIs, and single positive blood cultures (SPBCs).
- Data on all BSIs and central-line days were collected monthly.
Main Results:
- A total of 1,110 BSIs were reported, comprising 63.8% CLABSIs, 15.3% secondary BSIs, and 20.9% SPBCs.
- Most SPBCs (75%) occurred in profoundly neutropenic patients, with viridans group streptococci being common (22%).
- CLABSI rates were higher and secondary BSI rates lower after NHSN updated its definition for secondary BSIs (P<.001).
Conclusions:
- Tracking all BSIs, beyond just CLABSIs, in PHO patients offers a more clinically relevant assessment.
- This comprehensive approach facilitates better evaluation of infection rate differences within and between centers.
- Informed decision-making for healthcare providers, payors, and the public is enabled by this patient-centered strategy.
Abstract:
OBJECTIVE To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate DESIGN Prospective cohort study SETTING US multicenter, quality-improvement, BSI prevention network PARTICIPANTS PHO centers across the United States who agreed to follow a standardized central-line-maintenance care bundle and track all BSI events and central-line days every month. METHODS Infections were categorized as CLABSI (stratified by mucosal barrier injury-related, laboratory-confirmed BSI [MBI-LCBI] versus non-MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked. RESULTS Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P<.001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates. CONCLUSIONS Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. Infect Control Hosp Epidemiol 2017;38:690-696.