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Are enteral devices risk factors for central line-associated bloodstream infections in children with intestinal
D Gattini1, A Murphy2, C Belza3
1Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology & Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, Ontario, Canada.
Insights
Enteral devices like feeding tubes and stomas do not increase central line-associated bloodstream infections (CLABSI) in children with intestinal failure. However, prematurity, male sex, early diagnosis, and reduced small bowel length are risk factors for CLABSI.
Area of Science:
- Pediatric Gastroenterology
- Infectious Disease Epidemiology
- Clinical Nutrition
Background:
- Central line-associated bloodstream infections (CLABSI) are a significant complication in children with intestinal failure (IF).
- Enteral devices, such as feeding tubes and stomas, are commonly used in this patient population.
Purpose of the Study:
- To investigate the association between enteral device use and the rate of CLABSI in children with IF.
- To evaluate the impact of enteral devices on the time to the first CLABSI event.
- To identify other risk factors contributing to CLABSI in this cohort.
Main Methods:
- Retrospective cohort study of 202 children with IF receiving home parenteral nutrition.
- Analysis using negative binomial regression for CLABSI rates and Cox proportional hazard regression for time to first CLABSI.
- Adjustment for clinically relevant confounding factors.
Main Results:
- Enteral feeding tubes and stomas were not significantly associated with an increased rate of CLABSI.
- Enteral devices also did not show a significant association with the time to the first CLABSI episode.
- Factors significantly associated with higher CLABSI rates included prematurity, male sex, age at IF diagnosis <1 year, reduced small bowel length (<50%), and small bowel bacterial overgrowth (SBBO).
- Reduced small bowel length (<50%) was the only factor significantly associated with a longer time to the first CLABSI event.
Conclusions:
- Enteral feeding tubes and stomas are not independent risk factors for CLABSI in children with intestinal failure.
- Prematurity, male sex, early age at diagnosis, short small bowel length, and SBBO are key risk factors for CLABSI in this population.
- Further prospective, multicenter research is needed to refine CLABSI prevention strategies and identify high-risk patients.
Background & Aims:
Central line-associated bloodstream infections (CLABSI) represent one of the most common and serious complications in children with intestinal failure (IF). This study aimed to assess if there is an association between the use of enteral devices (feeding tubes and stomas) with rate of CLABSI after adjusting for clinically relevant factors. Second, association between enteral devices with time to first CLABSI event was evaluated.
Methods:
Retrospective cohort of 202 children with IF and home parenteral nutrition treated at The Hospital for Sick Children between January 2006, and December 2017, with a minimum of 12 months of follow-up. Negative binomial multivariable regression model was used to assess factors associated with rate of CLABSI. Cox proportional hazard regression model was used to assess factors associated with time to first CLABSI event.
Results:
The use of feeding tubes [RR 1.10 (95%CI 0.88-1.37); p = 0.407] or stomas [RR 1.00 (95%CI 0.82-1.22); p = 0.974] was not associated with rate of CLABSI after adjusting for confounding factors. There was a significant association between history of prematurity [RR 1.36 (95%CI 1.09-1.70); p = 0.007], male sex [RR 1.28 (95%CI 1.05-1.56); p = 0.016], age at diagnosis of intestinal failure <1 year [RR 2.41 (95%CI 1.75-3.33); p < 0.001], having <50 % of small bowel length expected for age [RR 2.39 (95%CI 1.87-3.05); P < 0.001], and small bowel bacterial overgrowth (SBBO) [RR 1.38 (95%CI 1.10-1.74); p = 0.006], with rate of CLABSI events after multivariable analysis. The use of feeding tubes [HR 0.79 (95%CI 0.49-1.26); p = 0.315] or stomas [HR 1.25 (95%CI 0.81-1.94); p = 0.308] was not associated with time to first CLASBSI episode after multivariable regression analysis. Only length of small bowel <50 % was associated with time to first CLABSI event on multivariable analysis [HR 1.83 (95%CI 1.14-2.93); p = 0.012].
Conclusion:
Feeding tubes and stomas were not associated with increased rate of CLABSI or time to first CLABSI episode. However, prematurity, male sex, age at diagnosis of intestinal failure <1 year, having <50 % of small bowel length expected for age, and SBBO were associated with rate of CLABSI events; and having <50 % of small bowel length was associated with time to first CLABSI event. Prospective, multicenter studies accounting for care delivery and prevention bundles are needed to identify patients that would benefit from additional interventions to prevent CLABSI.
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