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Published on: July 13, 2019
Risk factors for central line-associated bloodstream infection in the pediatric intensive care setting despite
Kaitlyn T Marks1, Katherine D Rosengard2, Jennifer D Franks1
1Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Department of Anaesthesia, Harvard Medical School, Boston, MA, United States.
Insights
Despite prevention measures, pediatric intensive care patients with chronic central venous catheters (CVCs) receiving parenteral nutrition, non-opioid sedatives, or prolonged CVC use face higher central line-associated bloodstream infection (CLABSI) risks.
Area of Science:
- Pediatric Intensive Care Medicine
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
Background:
- Central line-associated bloodstream infections (CLABSI) remain a significant concern in pediatric intensive care units (PICUs).
- Despite stringent prevention protocols, identifying persistent risk factors is crucial for reducing infection rates.
Purpose of the Study:
- To identify independent risk factors for CLABSI in a pediatric intensive care setting.
- To evaluate these risks in an era emphasizing infection prevention strategies.
Main Methods:
- A matched case-control study was conducted at a quaternary children's hospital.
- 129 cases of CLABSI were matched with 516 controls between January 2015 and December 2020.
- Multivariable, mixed-effects logistic regression analysis was employed.
Main Results:
- Central venous catheter (CVC) maintenance bundle compliance exceeded 70%.
- Independent risk factors for CLABSI included non-opioid sedative infusions, prolonged CVC dwell time, and combined chronic CVC use with parenteral nutrition.
- Factors associated with lower CLABSI odds included upper extremity CVC location, non-tunneled CVCs, and specific co-interventions like endotracheal tubes and H2 blockers.
Conclusions:
- Pediatric ICU patients with chronic CVCs on parenteral nutrition, non-opioid sedatives, or with extended CVC duration are at elevated CLABSI risk.
- These findings highlight specific patient populations and interventions that warrant targeted attention for CLABSI prevention.
- Further refinement of prevention strategies may be necessary for high-risk pediatric ICU patients.
Objective:
Identify risk factors for central line-associated bloodstream infections (CLABSI) in pediatric intensive care settings in an era with high focus on prevention measures.
Design:
Matched, case-control study.
Setting:
Quaternary children's hospital.
Patients:
Cases had a CLABSI during an intensive care unit (ICU) stay between January 1, 2015 and December 31, 2020. Controls were matched 4:1 by ICU and admission date and did not develop a CLABSI.
Methods:
Multivariable, mixed-effects logistic regression.
Results:
129 cases were matched to 516 controls. Central venous catheter (CVC) maintenance bundle compliance was >70%. Independent CLABSI risk factors included administration of continuous non-opioid sedative (adjusted odds ratio (aOR) 2.96, 95% CI [1.16, 7.52], P = 0.023), number of days with one or more CVC in place (aOR 1.42 per 10 days [1.16, 1.74], P = 0.001), and the combination of a chronic CVC with administration of parenteral nutrition (aOR 4.82 [1.38, 16.9], P = 0.014). Variables independently associated with lower odds of CLABSI included CVC location in an upper extremity (aOR 0.16 [0.05, 0.55], P = 0.004); non-tunneled CVC (aOR 0.17 [0.04, 0.63], P = 0.008); presence of an endotracheal tube (aOR 0.21 [0.08, 0.6], P = 0.004), Foley catheter (aOR 0.3 [0.13, 0.68], P = 0.004); transport to radiology (aOR 0.31 [0.1, 0.94], P = 0.039); continuous neuromuscular blockade (aOR 0.29 [0.1, 0.86], P = 0.025); and administration of histamine H2 blocking medications (aOR 0.17 [0.06, 0.48], P = 0.001).
Conclusions:
Pediatric intensive care patients with chronic CVCs receiving parenteral nutrition, those on non-opioid sedative infusions, and those with more central line days are at increased risk for CLABSI despite current prevention measures.
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