Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T15:18:35.561Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Central Line–Associated Bloodstream Infection in Pediatric Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Matthew C. Wylie ,
Dionne A. Graham ,
Gail Potter-Bynoe ,
Monica E. Kleinman ,
Adrienne G. Randolph ,
John M. Costello  and
Thomas J. Sandora
Matthew C. Wylie*
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
Dionne A. Graham
Affiliation:
Clinical Research Program, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
Gail Potter-Bynoe
Affiliation:
Infection Prevention and Control Program, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
Monica E. Kleinman
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
Adrienne G. Randolph
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
John M. Costello
Affiliation:
Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Infection Prevention and Control Program, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts Division of Infectious Diseases, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts Department of Laboratory Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
*
Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, 300 Longwood Avenue, Bader 634, Boston, MA 02115, (matthew.wylie@childrens.harvard.edu)
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

We sought to identify risk factors for central line-associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions.

Design.

Case-control study of children admitted to the medical-surgical intensive care unit (ICU) or cardiac ICU from January 1, 2004, through December 31, 2007.

Setting.

Children's Hospital Boston is a freestanding, 396-bed quaternary care pediatric hospital with a 29-bed medical-surgical ICU and a 24-bed cardiac ICU.

Patients.

Case patients were patients with CLABSI who were identified by means of prospective surveillance. Control subjects were patients with a central venous catheter who were matched by ICU admission date.

Methods.

Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI and to derive and to validate a prediction rule.

Results.

Two hundred three case patients were matched with 406 control subjects. Independent predictors of CLABSI included duration of ICU central access (odds ratio [OR] for 15 or more days, 18.41 [95% confidence interval {CI} 4.10-82.56]; P < .001), central venous catheter placement in the ICU (OR for 2 or more ICU-placed catheters, 8.63 [95% CI, 2.63-28.38]; P = .001), nonoperative cardiovascular disease (OR, 7.44 [95% CI, 2.13-25.98]; P = .012), presence of gastrostomy tube (OR, 3.48 [95% CI, 1.55-7.79]; P = .003), receipt of parenteral nutrition (OR, 3.12 [95% CI, 1.55-6.32]; P= .002), and receipt of blood transfusion (OR, 2.55 [95% CI, 1.21-5.36]; P = .014). By use of risk factors known before central venous catheter placement, our model predicted CLABSI with a positive predictive value of 54% and a negative predictive value of 79%.

Conclusions.

Duration of central access, receipt of parenteral nutrition, and receipt of blood transfusion were confirmed as risk factors for CLABSI among children in the ICU. Newly identified risk factors include presence of gastrostomy tube, nonoperative cardiovascular disease, and ICU placement of central venous catheter. Children with these risk factors may be candidates for adjunctive interventions for CLABSI prevention.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 10 , October 2010 , pp. 1049 - 1056
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RRNosocomial infections in pediatric intensive care units in the United States. Pediatrics 1999;103:e39.CrossRefGoogle ScholarPubMed
2.Mermel, LA. Prevention of intravascular catheter-related infections [published correction appears in Ann Intern Med2000;133(5):395]. Ann Intern Med 2000;132(5):391–402.Google Scholar
3.Raad, I. Intravascular catheter-related infections. Lancet 1998;351:893–898.CrossRefGoogle ScholarPubMed
4.Donowitz, LG. High risk of nosocomial infection in the pediatric critical care patient. Crif Care Med 1986;14:26–29.Google Scholar
5.Miliken, J, Tait, GA, Ford-Jones, EL, Mindorff, CM, Gold, R, Muilins, G. Nosocomial infections in a pediatric intensive care unit. Crif Care Med 1988;16:233–237.CrossRefGoogle Scholar
6.Ford-Jones, EL, Mindorff, CM, Langley, JM, et al.Epidemiologic study of 4,684 hospital-acquired infections in pediatric patients. Pediatr Infect Dis J 1989;8:668–675.CrossRefGoogle Scholar
7.Edwards, JR, Peterson, KD, Andrus, ML, et al.National Healthcare Safety Network (NHSN) report, data summary for 2006. Am J Infect Control 2007;35:290–301.CrossRefGoogle ScholarPubMed
8.Grohskopf, LA, Sinkowitz-Cochran, RL, Garrett, DO, et al.A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr 2002;140(4):432–438.Google Scholar
9.Crone, RK. Pediatric and neonatal intensive care. Can J Anaesth 1988;35(3 pt 2):S30–S33.Google Scholar
10.Pittet, D, Tarara, D, Wenzel, RRNosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
11.Roberts, RR, Scott, RD, Cordell, R, et al.The use of economic modeling to determine the hospital costs associated with nosocomial infections. Clin Infect Dis 2003;36:1424–1432.CrossRefGoogle ScholarPubMed
12.Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.CrossRefGoogle ScholarPubMed
13.Slonim, AD, Kurtines, HC, Sprague, BM, Singh, N. The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatr Crit Care Med 2001;2:170–174.CrossRefGoogle ScholarPubMed
14.Elward, AM, Hollenbeak, CS, Warren, DK, Fraser, VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2005;115(4):868–872.Google Scholar
15.Dominguez, TE, Chalom, R, Costarino, AT. The impact of adverse patient occurrences on hospital costs in the pediatric intensive care unit. Crit Care Med 2001;29:169–174.Google Scholar
16.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
17.Jeffries, HE, Mason, W, Brewer, M, et al.Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol 2009;30(7):645–651.CrossRefGoogle ScholarPubMed
18.Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med 1997;127:257–266.CrossRefGoogle ScholarPubMed
19.Raad, I, Darouiche, R, Dupuis, J. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections: a randomized, double-blind trial: the Texas Medical Center Catheter Study Group. Ann Intern Med 1997;127:267–274.Google Scholar
20.Darouiche, RO, Raad, II, Heard, SO, et al.A comparison of two antimicrobial-impregnated central venous catheters: Catheter Study Group. N Engl J Med 1999;340:1–8.CrossRefGoogle ScholarPubMed
21.Hanna, HA, Raad, II, Hackett, B, et al; M.D. Anderson Catheter Study Group. Antibiotic-impregnated catheters associated with significant decrease in nosocomial and multidrug-resistant bacteremias in critically ill patients. Chest 2003;124:1030–1038.Google Scholar
22.Chelliah, A, Heydon, KH, Zaoutis, TE, et al.Observational trial of antibiotic-coated central venous catheters in critically ill pediatric patients. Pediatr Infect Dis J 2007;26:816–820.Google Scholar
23.Bhutta, A, Gilliam, C, Honeycutt, M, et al.Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ 2007;334:362–365.Google Scholar
24.Garland, JS, Alex, CP, Mueller, CD, et al.A randomized trial comparing povidone-iodine to a Chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001;107:1431–1436.Google Scholar
25.Levy, I, Katz, J, Solter, E, et al.Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J 2005;24:676–679.Google Scholar
26.Timsit, JF, Schwebel, C, Bouadma, L, et al.Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009;301(12):1231–1241.CrossRefGoogle ScholarPubMed
27.Bleasdale, SC, Trick, WE, Gonzales, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:2073–2079.Google Scholar
28.Carratala, J, Niubo, J, Fernandez-Sevilla, A, et al.Randomized, double-blind trial of an antibiotic-lock technique for prevention of gram-positive central venous catheter-related infection in neutropenic patients with cancer. Antimicrob Agents Chemother 1999;43:2200–2204.Google Scholar
29.Henrickson, KJ, Axteil, RA, Hoover, SM, et al.Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: a randomized, multicenter, double-blind trial. J Clin Oncol 2000;18:1269–1278.Google Scholar
30.Safdar, N, Maki, DG. Use of vancomycin-containing lock or flush solutions for prevention of bloodstream infection associated with central venous access devices: a meta-analysis of prospective, randomized trials. Clin Infect Dis 2006;43:474–484.Google Scholar
31.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2004:1659–1702.Google Scholar
32.Costello, JM, Forbes-Morrow, D, Graham, DA, Potter-Bynoe, G, Sandora, TJ, Laussen, PC. Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 2008;121:915–923.Google Scholar
33.El-masri, MM, Hammad, TA, Fox-Wassylyshyn, SM. Predicting nosocomial bloodstream infections using surrogate markers of injury severity: clinical and methodological perspectives. Nurs Res 2005;54(4):273–279.CrossRefGoogle ScholarPubMed
34.Elward, AM, Fraser, VI. Risk factors for nosocomial primary bloodstream infection in pediatric intensive care unit patients: a 2-year prospective cohort study. Infect Control Hosp Epidemiol 2006;27:553–560.CrossRefGoogle ScholarPubMed
35.Costello, JM, Graham, DA, Morrow, DF, Potter-Bynoe, G, Sandora, TJ, Laussen, PC. Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatr Crit Care Med 2009;10(4):453–459.CrossRefGoogle Scholar
36.Christensen, ML, Hancock, ML, Gattuso, J, et al.Parenteral nutrition associated with increased infection rate in children with cancer. Cancer 1993;72:2732–2738.Google Scholar
37.Howell, PB, Walters, PE, Donowitz, GR, Farr, BM. Risk factors for infection of adult patients with cancer who have tunneled central venous catheters. Cancer 1995;75:1367–1375.Google Scholar
38.Shaul, DB, Scheer, B, Rokhsar, S, et al.Risk factors for early infection of central venous catheters in pediatric patients. J Am Coll Surg 1998;186:654–658.Google Scholar
39.Gorelick, MH, Owen, WC, Seibel, NL, Reaman, GH. Lack of association between neutropenia and the incidence of bacteremia associated with indwelling central venous catheters in febrile pediatric cancer patients. Pediatr Infect Dis J 1991;10:506–510.Google Scholar
40.Yogaraj, JS, Elward, AM, Fraser, VJ. Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2002;110(3):481–485.CrossRefGoogle ScholarPubMed