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Novel risk factors for central-line associated bloodstream infections in critically ill children
Charlotte Z Woods-Hill1,2, Lakshmi Srinivasan3, Emily Schriver4,5
1Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Novel risk factors for central-line-associated bloodstream infections (CLABSI) in critically ill children include behavioral health needs and frequent central line use. Interventions targeting these may reduce CLABSI rates.
Area of Science:
- Pediatric Intensive Care Medicine
- Infectious Disease Epidemiology
- Patient Safety Research
Background:
- Central-line-associated bloodstream infections (CLABSI) are a significant cause of morbidity and mortality in critically ill children.
- Identifying novel and modifiable risk factors is crucial for developing effective infection prevention strategies in the pediatric intensive care unit (PICU).
Purpose of the Study:
- To examine novel and modifiable risk factors for CLABSI in a pediatric intensive care unit (PICU) population.
- To identify potential new targets for CLABSI prevention strategies.
Main Methods:
- A single-center retrospective matched case-control study was conducted in a 60-bed PICU.
- Case patients with CLABSI were matched 1:4 with control patients based on age, complex chronic conditions, and hospital length of stay.
- Data were collected from April 1, 2013, to December 31, 2017.
Main Results:
- Four significant risk factors for CLABSI were identified in multivariable analysis.
- These included a high total number of central line accesses (≥80 in 3 days), acute behavioral health needs, prolonged central venous catheter (CVC) duration (>7 days), and hematologic/immunologic disease.
- Specific odds ratios indicated increased risk with increased CVC duration and high access frequency.
Conclusions:
- Acute behavioral health needs and frequent central line access (>80 in 3 days) are novel risk factors for CLABSI in PICU patients.
- Targeted interventions focusing on these modifiable factors may help reduce CLABSI rates in this vulnerable population.
Objective:
Central-line-associated bloodstream infections (CLABSI) cause morbidity and mortality in critically ill children. We examined novel and/or modifiable risk factors for CLABSI to identify new potential targets for infection prevention strategies.
Methods:
This single-center retrospective matched case-control study of pediatric intensive care unit (PICU) patients was conducted in a 60-bed PICU from April 1, 2013, to December 31, 2017. Case patients were in the PICU, had a central venous catheter (CVC), and developed a CLABSI. Control patients were in the PICU for ≥2 days, had a CVC for ≥3 days, and did not develop a CLABSI. Cases and controls were matched 1:4 on age, number of complex chronic conditions, and hospital length of stay.
Results:
Overall, 72 CLABSIs were matched to 281 controls. Univariate analysis revealed 14 risk factors, and 4 remained significant in multivariable analysis: total number of central line accesses in the 3 days preceding CLABSI (80+ accesses: OR, 4.8; P = .01), acute behavioral health needs (OR, 3.2; P = .02), CVC duration >7 days (8-14 days: OR, 4.2; P = .01; 15-29 days: OR, 9.8; P < .01; 30-59 days: OR, 17.3; P < .01; 60-89 days: OR, 39.8; P < .01; 90+ days: OR, 4.9; P = .01), and hematologic/immunologic disease (OR, 1.5; P = .05).
Conclusions:
Novel risk factors for CLABSI in PICU patients include acute behavioral health needs and >80 CVC accesses in the 3 days before CLABSI. Interventions focused on these factors may reduce CLABSIs in this high-risk population.
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