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Risk factors for central line-associated bloodstream infection in the pediatric intensive care setting despite standard prevention measures

Published online by Cambridge University Press:  10 October 2024

Kaitlyn T Marks Open the ORCID record for Kaitlyn T Marks [Opens in a new window] ,
Katherine D Rosengard Open the ORCID record for Katherine D Rosengard [Opens in a new window] ,
Jennifer D Franks ,
Steven J Staffa ,
Jenny Chan Yuen ,
Jeffrey P Burns ,
Gregory P Priebe  and
Thomas J Sandora Open the ORCID record for Thomas J Sandora [Opens in a new window]
Kaitlyn T Marks*
Affiliation:
Division 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
Katherine D Rosengard
Affiliation:
Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
Jennifer D Franks
Affiliation:
Division 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
Steven J Staffa
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, United States
Jenny Chan Yuen
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, MA, United States
Jeffrey P Burns
Affiliation:
Division 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
Gregory P Priebe
Affiliation:
Division 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 Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
Thomas J Sandora
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, MA, United States Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
*
Corresponding author: Kaitlyn T Marks; Email: [email protected]
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Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 11 , November 2024 , pp. 1271 - 1279
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

#

Kaitlyn T. Marks is now a member of the Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States.

*

Co-senior authors.

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