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Pediatric Ambulatory Central Line-Associated Bloodstream Infections
Michael L Rinke1,2, Moonseong Heo3, Lisa Saiman4
1The Children's Hospital at Montefiore, Bronx, New York; mrinke@montefiore.org.
Insights
Ambulatory pediatric central line-associated bloodstream infections (CLABSIs) are common and lead to hospitalization. Catheter type, low albumin, and antimicrobial use are key factors influencing CLABSI risk in children.
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.
Background:
Inpatient pediatric central line-associated bloodstream infections (CLABSIs) cause morbidity and increased health care use. Minimal information exists for ambulatory CLABSIs despite ambulatory central line (CL) use in children. In this study, we identified ambulatory pediatric CLABSI incidence density, risk factors, and outcomes.
Methods:
Retrospective cohort with nested case-control study at 5 sites from 2010 through 2015. Electronic queries were used to identify potential cases on the basis of administrative and laboratory data. Chart review was used to confirm ambulatory CL use and adjudicated CLABSIs. Bivariate followed by multivariable backward logistic regression was used to identify ambulatory CLABSI risk factors.
Results:
Queries identified 4600 potentially at-risk children; 1658 (36%) had ambulatory CLs. In total, 247 (15%) patients experienced 466 ambulatory CLABSIs with an incidence density of 0.97 CLABSIs per 1000 CL days. Incidence density was highest among patients with tunneled externalized catheters versus peripherally inserted central catheters and totally implanted devices: 2.58 CLABSIs per 1000 CL days versus 1.46 vs 0.23, respectively (P < .001). In a multivariable model, clinic visit (odds ratio [OR] 2.8; 95% confidence interval [CI]: 1.4-5.5) and low albumin (OR 2.3; 95% CI: 1.2-4.3) were positively associated with CLABSI, and prophylactic antimicrobial agents for underlying conditions within the preceding 30 days (OR 0.22; 95% CI: 0.12-0.40) and operating room CL placement (OR 0.36; 95% CI: 0.16-0.79) were inversely associated with CLABSI. A total of 396 patients (85%) were hospitalized because of ambulatory CLABSI with an 8-day median length of stay (interquartile range 5-13).
Conclusions:
Ambulatory pediatric CLABSI incidence density is appreciable and associated with health care use. CL type, patients with low albumin, prophylactic antimicrobial agents, and placement setting may be targets for reduction efforts.
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