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Published on: February 23, 2014
Central Line-Associated Bloodstream Infection Risk Factors in a Pediatric Population
Hannah E Trembath1, Deanna M Caruso1, Sean E McLean2
1Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA.
Insights
Central line type and reason for placement significantly impact pediatric bloodstream infection rates. Peripherally inserted central catheters (PICCs) and ports are associated with lower infection risks compared to other central venous lines.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Vascular access device management
Background:
- Central venous line (CVL) placement is crucial for pediatric treatment but carries a risk of central line-associated bloodstream infection (CLABSI).
- Understanding factors influencing CLABSI rates is vital for patient safety and effective treatment strategies.
Purpose of the Study:
- To investigate the association between central venous line type, clinical indications, and demographic factors with CLABSI rates in pediatric patients.
- To identify specific line types and indications that may increase or decrease the risk of CLABSI.
Main Methods:
- A single-institution case-control study involving pediatric patients (≤18 years) admitted between 2015 and 2019.
- Case patients had documented CLABSI; control patients had CVLs placed and were matched by sex and age (2:1 ratio).
- Bivariate and multivariate logistic regression analyses were performed to assess risk factors.
Main Results:
- Patients with tunneled or non-tunneled CVLs had higher odds of CLABSI compared to those with peripherally inserted central catheters (PICCs).
- Port placement was associated with decreased odds of CLABSI compared to PICCs.
- Lines placed for intravenous medications had lower odds of CLABSI compared to those placed for solid tumors.
Conclusions:
- PICC and port placement in appropriate pediatric patients may help reduce CLABSI rates.
- Central lines placed for medication administration are associated with lower CLABSI risk than those for solid tumors.
- Further research and targeted interventions focusing on PICC and port utilization are recommended to mitigate CLABSI.
Background:
Central venous line (CVL) placement in children is often necessary for treatment and may be complicated by central line-associated bloodstream infection (CLABSI). We hypothesize that line type and clinical and demographic factors at line placement impact CLABSI rates.
Methods:
This is a single-institution case-control study of pediatric patients (≤18 years old) admitted between January 1, 2015, and December 31, 2019. Case patients had a documented CLABSI. Control patients had a CVL placed during the study period and were matched by sex and age in a 2:1 ratio. Bivariate and multivariate logistic regression analysis was performed.
Results:
We identified 78 patients with a CLABSI and 140 patients without a CLABSI. After controlling for pertinent covariates, patients undergoing tunneled or non-tunneled CVL had higher odds of CLABSI than those undergoing PICC (OR 2.51, CI 1.12-5.64 and OR 3.88, CI 1.06-14.20 respectively), and patients undergoing port placement had decreased odds of CLABSI compared to PICC (OR .05, CI 0.01-.51). There were lower odds of CLABSI when lines were placed for intravenous medications compared to those placed for solid tumor malignancy (OR .15, CI .03-.79). Race and age were not statistically significant risk factors.
Discussion:
Central lines placed for medication administration compared to solid tumors, PICC compared to tunneled and non-tunneled central lines, and ports compared to PICC were associated with lower odds of CLABSI. Future improvement efforts should focus on PICC and port placement in appropriate patients to decrease CLABSI rates.
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