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The Frequency of Multiple Central Line-Associated Bloodstream Infections (CLABSIs) Occurring in the Same Child: A
Insights
Repeat central line-associated bloodstream infections (CLABSIs) are common, affecting over a quarter of infections. Previous CLABSIs significantly increase the risk of future infections in pediatric patients.
Area of Science:
- Infectious Disease Epidemiology
- Pediatric Healthcare Quality
Background:
- Central line-associated bloodstream infections (CLABSIs) are a significant concern in pediatric healthcare.
- Understanding the recurrence of CLABSIs within the same patient is crucial for effective infection control.
Purpose of the Study:
- To analyze the frequency of multiple CLABSIs in pediatric patients over a five-year period.
- To assess the impact of prior CLABSI as a risk factor for subsequent infections.
- To evaluate the implications of recurrent CLABSIs on overall infection rate calculations.
Main Methods:
- Retrospective analysis of a five-year institutional CLABSI surveillance data.
- Inclusion of central line days, CLABSI counts, and categorization of mucosal barrier injury (MBI) and non-MBI CLABSIs.
- Calculation of the proportion of CLABSIs attributed to patients with multiple infections.
Main Results:
- 138 CLABSIs occurred in 119 pediatric patients over five years.
- 26.1% of CLABSIs were in patients with multiple infections; 13.8% were repeat infections.
- Excluding repeat CLABSIs reduced the calculated CLABSI rate by 13.7%.
Conclusions:
- Recurrent CLABSIs in the same patient are frequent and substantially impact reported infection rates.
- A history of CLABSI is a critical risk factor for developing future CLABSIs.
- CLABSI surveillance and reporting methodologies should account for repeat infections.
Background:
The aim of this study was to evaluate one institution's five-year experience with the frequency of multiple central line-associated bloodstream infections (CLABSIs) occurring in the same child and to discuss the importance of previous CLABSI as a risk factor for future CLABSI and the implications for CLABSI rate calculation.
Methods:
The infection surveillance system includes data on central line days, CLABSI rate, and CLABSI count, including mucosal barrier injury (MBI) and non-MBI CLABSIs. Using this data, the authors determined the number of children who had more than one inpatient CLABSI during a five-year period. The team then calculated the percentage of total CLABSIs that are represented by patients with more than one CLABSI and the percentage of patients with CLABSI who had multiple CLABSIs.
Results:
During the five-year study period, there were 138 CLABSIs in 119 patients. Of the 138 CLABSIs, 36 (26.1%) occurred in children who had more than one CLABSI and 19 (13.8%) of those were repeat. Seventeen patients had more than 1 inpatient CLABSI (15 patients with 2 CLABSIs, and 2 patients with 3 CLABSIs). The CLABSI rate for this period was 1.83 per 1,000 central line days. With exclusion of repeat CLABSIs, the CLABSI rate would be 1.58 per 1,000 central line days, representing a 13.7% difference.
Conclusion:
Repeat CLABSI in the same patient is not uncommon and can contribute significantly to overall inpatient CLABSI rates. Prior CLABSI should be considered a risk factor for future CLABSI.
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