Moving CLABSI Prevention beyond the Intensive Care Unit: Risk Factors in Pediatric Oncology Patients

Abstract

Background and Objective.Central line-associated bloodstream infections (CLABSIs) frequently complicate the use of central venous catheters (CVCs) among pediatric patients with cancer. Our objectives were to describe the microbiology and identify risk factors for hospital-onset CLABSI in this patient population.Design.Retrospective case-control study.Setting.Oncology and stem cell transplant units of a freestanding, 396-bed quaternary care pediatric hospital.Participants.Case subjects (N= 54) were patients with a diagnosis of malignancy and/or stem cell transplant recipients with CLABSI occurring during admission. Controls (N= 108) were identified using risk set sampling of hospitalizations among patients with a CVC, matched on date of admission.Methods.Multivariate conditional logistic regression was used to identify independent predictors of CLABSI.Results.The majority of CLABSI isolates were gram-positive bacteria (58%). The most frequently isolated organism wasEnterococcus faecium, and 6 of 9 isolates were resistant to vancomycin. In multivariate analyses, independent risk factors for CLABSI included platelet transfusion within the prior week (odds ratio [OR], 10.90 [95% confidence interval (CI), 3.02-39.38];P<.001) and CVC placement within the previous month (<1 week vs ≥1 month: OR, 11.71 [95% CI, 1.98-69.20];P= .02; ≥1 week and <1 month vs ≥1 month: OR, 7.37 [95% CI, 1.85-29.36];P= .004).Conclusions.Adjunctive measures to prevent CLABSI among pediatric oncology patients may be most beneficial in the month following CVC insertion and in patients requiring frequent platelet transfusions. Vancomycin-resistant enterococci may be an emerging cause of CLABSI in hospitalized pediatric oncology patients and are unlikely to be treated by typical empiric antimicrobial regimens.