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Changes in Central Line-Associated Bloodstream Infection (CLABSI) Rates Following Implementation of Levofloxacin
Lauri A Linder1,2, Cheryl Gerdy2, Yeonjung Jo3,4
1University of Utah College of Nursing, Salt Lake City, UT, USA.
Insights
Antibacterial prophylaxis with levofloxacin significantly reduced central line-associated bloodstream infections (CLABSI) in high-risk pediatric hematologic malignancy patients. This intervention proved more effective than standard care bundles alone.
Area of Science:
- Infectious Diseases
- Pediatric Oncology
- Healthcare Quality Improvement
Background:
- Central line-associated bloodstream infections (CLABSI) remain a significant risk for pediatric patients with hematologic malignancies, particularly those with relapsed disease.
- Despite existing initiatives, targeted interventions are crucial to further reduce infection rates in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of implementing antibacterial prophylaxis with levofloxacin on CLABSI rates in pediatric patients with high-risk hematologic malignancies.
- To compare the effectiveness of different CLABSI reduction strategies, including bundles, supportive care, and antibacterial prophylaxis.
Main Methods:
- A single-institution retrospective study analyzed CLABSI data from January 2006 to December 2019.
- Data were stratified into four periods based on the implementation of CLABSI reduction interventions.
- Conditional Poisson regression models assessed the effect of interventions on CLABSI rates, with post hoc Tukey pairwise comparisons.
Main Results:
- The baseline CLABSI rate was 4.84 per 1,000 line days.
- Implementation of Children's Hospital Association (CHA) bundles showed a non-significant decrease (3.29 per 1,000 line days, p=0.16).
- Formalized supportive care (2.66 per 1,000 line days, p<0.01) and antibacterial prophylaxis (1.66 per 1,000 line days, p<0.01) significantly reduced CLABSI rates. Antibacterial prophylaxis was significantly more effective than CHA bundles alone (IRR=0.49, p=0.011) and CHA bundles plus supportive care (IRR=0.58, p=0.046).
Conclusions:
- A practice-based evidence approach, particularly the use of antibacterial prophylaxis, led to sustained success in reducing CLABSI rates in high-risk pediatric hematologic malignancy patients.
- Future research utilizing machine learning may further identify risk factors and refine CLABSI prevention strategies.
Abstract:
Background: Despite initiatives to reduce central line-associated bloodstream infection (CLABSI), children and adolescents with hematologic malignancies, as well as those with relapsed disease, remain at the greatest risk for infection. This single-institution project evaluated changes in CLABSI rates following implementation of antibacterial prophylaxis with levofloxacin for patients with high-risk hematologic malignancies. Methods: Positive blood culture events meeting National Health Safety Network surveillance criteria to be classified as CLABSIs from January 1, 2006, to December 31, 2019, were included. Data were organized into four time periods for comparison based on implementation of CLABSI-reduction interventions. Conditional Poisson regression models were used to evaluate the effect of time (intervention period) on CLABSI rates with post hoc Tukey pairwise comparisons between each of the four time periods. Results: From 2006 and 2019, 227 patients experienced 310 CLABSIs. Clinically important decreases in CLABSI rates from baseline (4.84 per 1,000 line days) occurred with implementation of Children's Hospital Association (CHA) bundles (3.29 per 1,000 line days); however, this difference was not significant (p = .16). CLABSI rates decreased from baseline with the addition of formalized supportive cares (2.66 per 1,000 line days; incidence rate ratio [IRR] = 0.60; p < .01), and with the use of antibacterial prophylaxis (1.66 per 1,000 line days; IRR = 0.35; p < .01). Post hoc comparisons indicated decreased CLABSI rates with the use of antibacterial prophylaxis compared with CHA bundles alone (IRR = 0.49; p = .011) and CHA bundles plus formalized supportive cares (IRR = 0.58; p = .046). Discussion: Results demonstrate sustained success using a practice-based evidence approach to guide CLABSI-reduction interventions. Follow-up research, applying machine learning algorithms, may identify additional risk factors and inform future interventions.
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