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The burden of central line-associated bloodstream infections in children with medical complexity
Alessia Scarselli1, Andrea Smarrazzo1, Francesco De Sanctis1
1Bambino Gesù Pediatric Hospital, Rome, Italy.
Insights
Central line-associated bloodstream infections (CLABSI) are a significant risk in pediatric intensive care units. Children with medical complexity (CMC) experience a higher CLABSI incidence, necessitating tailored prevention strategies.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Healthcare-associated infections
Background:
- Central line-associated bloodstream infections (CLABSI) pose serious risks in pediatric intensive care units (PICUs).
- Children with medical complexity (CMC) represent an increasing challenge for CLABSI prevention in PICUs.
- CMC are defined by chronic conditions requiring significant medical support, such as ventilation or feeding tubes.
Purpose of the Study:
- To evaluate the incidence of CLABSI in a PICU with a high prevalence of CMC.
- To compare CLABSI rates between CMC and non-CMC pediatric patients.
- To identify the microbial causes of CLABSI in this specific patient population.
Main Methods:
- Retrospective study conducted at Bambino Gesù Children Hospital PICU (January 2017-December 2020).
- Extraction of demographic, clinical, and microbiological data from patient medical records.
- CLABSI definition followed CDC/NHSN surveillance criteria.
Main Results:
- 101 children (79% CMC) with 125 central lines were analyzed.
- Overall CLABSI incidence was 2.75 per 1000 central line-days.
- CLABSI incidence was significantly higher in CMC (3.14/1000 CL-days) compared to zero in non-CMC patients (p < 0.001).
- Common pathogens included Gram-negative bacteria, Candida spp., and Staphylococcus hominis.
Conclusions:
- Achieving zero CLABSI is feasible in critically ill children without underlying conditions.
- CMC patients exhibit a high CLABSI incidence driven by a distinct microbial profile.
- Understanding this unique CLABSI ecology is crucial for effective antibiotic stewardship in CMC patients.
Background:
Central line-associated bloodstream infections (CLABSI) are significant cause of complications in pediatric intensive care units (PICUs). An emerging challenge are CLABSIs in children with medical complexity (CMC) admitted to PICU. CMC are patients with chronic conditions with or without neurological impairment needing for tracheostomy and/or home mechanical or non-invasive ventilation and/or gastrostomy/jejunostomy. We evaluate CLABSI incidence in a PICU with high prevalence of CMC.
Methods:
This was a retrospective study in the PICU of the Bambino Gesù Children Hospital from January 2017 to December 2020. The medical records were reviewed and demographic, clinical and microbiological data were extracted. CLABSI were defined according to the Center for Disease Control and Prevention's National Healthcare Safety Networks (NHSN) surveillance.
Results:
A total of 101 children with 125 central lines (CLs) were included; 79/101 (78%) patients were CMC and 50/101 (50%) had a thracheostomy. CLABSI incidence was 2.75/1000 CL-days (9 cases/3269 CL-days); incidence was 0 in patients without underling conditions and 3.14/1000 in CMC (p < 0.001). CLABSI were due to gram negative bacteria in five patients, Candida spp in three and Staphylococcus hominis in one. CLs were removed in eight cases while in the later one, with CLABSI due to Pseudomonas aeruginosa, a conservative strategy was adopted cause of unavailable alternative venous access and removed at discharge with negative culture. All patients recovered.
Conclusions:
A target 0% CLABSI was possible in critically ill children without underling condition while a high incidence was reported in CMC and sustained by a peculiar CLABSI ecology. This ecology should be considered when a CLABSI was suspected in CMC for prompt antibiotics stewardship.
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