Pediatric Ambulatory Central Line–Associated Bloodstream Infections-Reference-Cited by-同舟云学术

Pediatric Ambulatory Central Line–Associated Bloodstream Infections

Published:2021-01-01 Issue:1 Volume:147 Page:
ISSN:0031-4005
Container-title:Pediatrics
language:en
Short-container-title:

Author:

Rinke Michael L.¹²,Heo Moonseong³,Saiman Lisa⁴,Bundy David G.⁵,Rosenberg Rebecca E.⁶,DeLaMora Patricia⁷,Rabin Barbara⁸,Zachariah Philip⁴,Mirhaji Parsa²,Ford William J. H.⁶,Obaro-Best Oghale⁹,Drasher Michael¹⁰,Klein Elizabeth²,Peshansky Alexandre²,Oyeku Suzette O.¹²

Affiliation:

1. The Children’s Hospital at Montefiore, Bronx, New York;

2. Albert Einstein College of Medicine, Bronx, New York;

3. Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina;

4. Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York;

5. Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina;

6. Department of Pediatrics, School of Medicine, New York University, New York, New York;

7. Department of Pediatrics, Weill Cornell Medical College, New York, New York;

8. Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York;

9. Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York; and

10. School of Medicine, Wayne State University, Detroit, Michigan

Abstract

BACKGROUND: Inpatient pediatric central line–associated bloodstream infections (CLABSIs) cause morbidity and increased health care use. Minimal information exists for ambulatory CLABSIs despite ambulatory central line (CL) use in children. In this study, we identified ambulatory pediatric CLABSI incidence density, risk factors, and outcomes. METHODS: Retrospective cohort with nested case-control study at 5 sites from 2010 through 2015. Electronic queries were used to identify potential cases on the basis of administrative and laboratory data. Chart review was used to confirm ambulatory CL use and adjudicated CLABSIs. Bivariate followed by multivariable backward logistic regression was used to identify ambulatory CLABSI risk factors. RESULTS: Queries identified 4600 potentially at-risk children; 1658 (36%) had ambulatory CLs. In total, 247 (15%) patients experienced 466 ambulatory CLABSIs with an incidence density of 0.97 CLABSIs per 1000 CL days. Incidence density was highest among patients with tunneled externalized catheters versus peripherally inserted central catheters and totally implanted devices: 2.58 CLABSIs per 1000 CL days versus 1.46 vs 0.23, respectively (P < .001). In a multivariable model, clinic visit (odds ratio [OR] 2.8; 95% confidence interval [CI]: 1.4–5.5) and low albumin (OR 2.3; 95% CI: 1.2–4.3) were positively associated with CLABSI, and prophylactic antimicrobial agents for underlying conditions within the preceding 30 days (OR 0.22; 95% CI: 0.12–0.40) and operating room CL placement (OR 0.36; 95% CI: 0.16–0.79) were inversely associated with CLABSI. A total of 396 patients (85%) were hospitalized because of ambulatory CLABSI with an 8-day median length of stay (interquartile range 5–13). CONCLUSIONS: Ambulatory pediatric CLABSI incidence density is appreciable and associated with health care use. CL type, patients with low albumin, prophylactic antimicrobial agents, and placement setting may be targets for reduction efforts.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Link

https://publications.aap.org/pediatrics/article-pdf/doi/10.1542/peds.2020-0524/1082140/peds_20200524.pdf

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