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

Published online by Cambridge University Press:  02 January 2015

Matthew Kelly
Affiliation:
Department of Medicine, Childern's Hospital Boston, Boston, Massachusetts
Margaret Conway
Affiliation:
Medicine Patient Services, Childern's Hospital Boston, Boston, Massachusetts
Kathleen Wirth
Affiliation:
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
Gail Potter-Bynoe
Affiliation:
Infection Prevention and Control, Children's Hospital Boston, Boston, Massachusetts
Amy L. Billett
Affiliation:
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts and Division of Hematology/Oncology, Children's Hospital Boston, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Department of Medicine, Childern's Hospital Boston, Boston, Massachusetts Infection Prevention and Control, Children's Hospital Boston, Boston, Massachusetts Division of Infectius Diseases, Childern's Hospital Boston, Boston, Massachusetts; and Department of Laboratory Medicine, Childern's Hospital Boston, Boston, Massachusetts
Corresponding
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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 was Enterococcus 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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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