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Central line-associated bloodstream infections in children: a systematic review and meta-analysis
Lixiang Li1, Yingshan Zheng2, Weiying Deng3
1Catheterization Center, Foshan First People's Hospital, Foshan, China.
Insights
Blood transfusions, congenital diseases, parenteral nutrition, and catheter practices significantly increase central line-associated bloodstream infections (CLABSI) in children. Early catheter removal and careful blood product use are key prevention strategies.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Epidemiology
- Healthcare-Associated Infections
Background:
- Central line-associated bloodstream infection (CLABSI) presents challenges in pediatric care.
- Identifying modifiable risk factors is crucial for effective prevention strategies.
- Existing research shows heterogeneity, necessitating a synthesized evidence approach.
Purpose of the Study:
- To systematically review and quantify key risk factors for CLABSI in pediatric patients.
- To consolidate data from observational studies to inform clinical practice.
- To provide a meta-analysis of modifiable risk factors for pediatric CLABSI.
Main Methods:
- Comprehensive literature search of major databases (PubMed, Embase, etc.) up to April 2024.
- Inclusion of 17 observational studies (cohort) with 15,221 pediatric patients.
- Random-effects meta-analysis using pooled odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Significant risk factors identified: blood transfusions (OR=5.69), congenital diseases (OR=2.58), CNS diseases (OR=4.13), parenteral nutrition (OR=4.37), multiple catheters (OR=4.16), and prolonged catheterization (OR=1.19).
- Subgroup analyses indicated consistency across different regions and study types.
- Heterogeneity was low for most factors (I²<50%).
Conclusions:
- Blood transfusions, congenital/CNS comorbidities, parenteral nutrition, and catheter practices are critical modifiable risk factors for pediatric CLABSI.
- Clinical recommendations include prioritizing early catheter removal and judicious blood product use.
- Findings support enhanced pediatric-specific CLABSI prevention protocols.
Background:
Central line-associated bloodstream infection (CLABSI) in pediatric patients poses significant clinical challenges, with prevention strategies heavily reliant on identifying modifiable risk factors. Despite numerous studies investigating these risk factors, heterogeneity in study designs, populations, and regional settings necessitates a systematic synthesis of evidence to guide clinical practice. This meta-analysis aims to consolidate existing data and quantify key risk factors for pediatric CLABSI.
Methods:
A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for observational studies (cohort and case-control) published up to April 1, 2024. Two independent reviewers screened studies, extracted data, and assessed quality using the MOOSE checklist for observational meta-analyses. Meta-analyses were performed using Stata 15.0 software, with pooled odds ratios (ORs) and 95% confidence intervals (CIs) calculated via random-effects models. Heterogeneity was evaluated with I2 statistics.
Results:
Seventeen studies (17 cohort studies) involving 15,221 pediatric patients were included. Significant risk factors for CLABSI were: blood transfusions (OR =5.69; 95% CI: 2.93-11.05), congenital diseases (OR =2.58; 95% CI: 1.14-5.83), central nervous system (CNS) diseases (OR =4.13; 95% CI: 1.17-9.98), total parenteral nutrition (OR =4.37; 95% CI: 1.14-16.82), multiple catheters (OR =4.16; 95% CI: 2.36-7.31), prolonged catheterization time (OR =1.19; 95% CI: 1.08-1.30). Subgroup analyses confirmed consistency across regions and study types (I2<50% for most factors).
Conclusions:
This meta-analysis identifies blood transfusions, congenital/CNS comorbidities, parenteral nutrition, and catheter-related practices as critical modifiable risk factors for pediatric CLABSI. Clinicians should prioritize early catheter removal, judicious blood product use, and intensified monitoring for high-risk patients. These findings align with existing guidelines but provide stronger evidence for pediatric-specific protocols.
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