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Area of Science:

  • Pediatric Medicine
  • Infectious Diseases
  • Healthcare Epidemiology

Background:

  • Pediatric central line-associated bloodstream infections (CLABSIs) are a significant cause of morbidity and increased healthcare utilization in inpatients.
  • Limited data exists on CLABSIs in ambulatory pediatric settings, despite the increasing use of central lines (CLs) in this population.

Purpose of the Study:

  • To determine the incidence density of ambulatory pediatric CLABSIs.
  • To identify risk factors associated with ambulatory CLABSIs in children.
  • To describe the outcomes of ambulatory pediatric CLABSIs.

Main Methods:

  • A retrospective cohort study with a nested case-control design was conducted across five sites from 2010 to 2015.
  • Electronic queries identified potential cases, followed by chart review for confirmation of ambulatory CL use and CLABSI adjudication.
  • Multivariable logistic regression analysis was employed to identify risk factors for ambulatory CLABSIs.

Main Results:

  • The study identified 1658 children with ambulatory CLs, with 247 experiencing 466 CLABSIs, yielding an incidence density of 0.97 CLABSIs per 1000 CL days.
  • Tunneled externalized catheters had the highest incidence density (2.58 per 1000 CL days).
  • Clinic visits (OR 2.8) and low albumin (OR 2.3) were associated with increased CLABSI risk, while prophylactic antimicrobials (OR 0.22) and operating room CL placement (OR 0.36) were associated with decreased risk. 85% of patients were hospitalized, with a median stay of 8 days.

Conclusions:

  • Ambulatory pediatric CLABSIs occur at an appreciable rate and are associated with significant healthcare utilization.
  • Central line type, patient factors like low albumin, and the use of prophylactic antimicrobial agents present potential targets for CLABSI reduction strategies.
  • Placement setting and antimicrobial prophylaxis appear to be modifiable factors for reducing ambulatory CLABSI incidence.