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Predictive Factors for Central Line-Associated Bloodstream Infections in Pediatric Cardiac Surgery Patients With
Stephanie G Waterhouse1, Jeffrey E Vergales2, Mark R Conaway3
1Department of Pediatric Critical Care, Vanderbilt University Medical Center, Nashville, TN.
Insights
Pediatric cardiac surgery patients with chylothorax have a higher risk of central line-associated bloodstream infections. Key risk factors include surgical complexity, longer catheter use, and chest tube output, aiding targeted prevention.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Cardiovascular surgery outcomes
Background:
- Central line-associated bloodstream infections (CLABSIs) are a significant concern in pediatric intensive care units (PICUs).
- Chylothorax, a complication following cardiac surgery, may increase the risk of CLABSIs in this vulnerable population.
- Identifying specific risk factors is crucial for effective prevention strategies.
Purpose of the Study:
- To determine the prevalence of CLABSIs in pediatric cardiac surgery patients with and without chylothorax.
- To identify risk factors associated with CLABSIs in pediatric patients with chylothorax post-cardiac surgery.
- To inform targeted interventions for high-risk individuals.
Main Methods:
- Retrospective single-center cohort study.
- Inclusion of all pediatric patients undergoing cardiac surgery and admitted to the PICU from 2008 to 2014.
- Analysis of patient data including chylothorax status, CLABSI occurrence, surgical complexity (Risk Adjustment Congenital Heart Surgery score), central venous catheter duration, and chest tube output.
Main Results:
- A total of 1,191 patients were analyzed; 66 (5.5%) had chylothorax.
- Patients with chylothorax had a significantly higher incidence of CLABSI (23% vs. 3.8%, p < 0.001).
- In patients with chylothorax, higher Risk Adjustment Congenital Heart Surgery score, longer central venous catheter duration, and increased 24-hour chest tube output predicted higher CLABSI risk.
Conclusions:
- The prevalence of CLABSI is elevated in pediatric cardiac surgery patients with chylothorax.
- Surgical complexity, prolonged central venous catheterization, and significant chest tube drainage are key predictors of CLABSI in this cohort.
- These findings enable the identification of high-risk patients for focused CLABSI prevention efforts.
Objectives:
To assess the prevalence of central line-associated bloodstream infections in pediatric patients with and without chylothorax after cardiac surgery and identify risk factors that predict those patients at highest risk for developing a central line-associated bloodstream infection.
Design:
Retrospective single-center cohort study.
Setting:
A PICU located within a tertiary-care academic pediatric hospital.
Patients:
All pediatric patients admitted to the PICU after cardiac surgery between 2008 and 2014.
Interventions:
None.
Measurements And Main Results:
We identified 1,191 pediatric cardiac surgery patients in the study time frame, of which 66 (5.5%) had chylothorax. Patients with chylothorax were more likely to have a central line-associated bloodstream infection (23% vs 3.8%; p < 0.001). Patients with both chylothorax and central line-associated bloodstream infection had longer durations of central venous catheter, higher Risk Adjustment Congenital Heart Surgery score, longer PICU stay, and higher mortality compared with patients with chylothorax who did not have a central line-associated bloodstream infection. Multivariable analysis identified higher Risk Adjustment Congenital Heart Surgery score, longer duration of central venous catheter, and higher chest tube output at 24 hours after initiating treatment for chylothorax to be predictive of increased central line-associated bloodstream infection risk in patients with chylothorax.
Conclusions:
The prevalence of central line-associated bloodstream infection is higher in pediatric patients with chylothorax after heart surgery. In patients with chylothorax, complexity of surgery, central venous catheter duration, and chest tube output are associated with increased risk for developing a central line-associated bloodstream infection. Using this knowledge will allow us to identify patients at increased risk for central line-associated bloodstream infections and to focus extra prevention efforts on them.
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