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Epidemiology of Central Line-Associated Bloodstream Infections in the Pediatric Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Matthew F. Niedner ,
W. Charles Huskins ,
Elizabeth Colantuoni ,
John Muschelli ,
J. Mitchell Harris II ,
Tom B. Rice ,
Richard J. Brilli  and
Marlene R. Miller
Matthew F. Niedner*
Affiliation:
Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
W. Charles Huskins
Affiliation:
Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Elizabeth Colantuoni
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
John Muschelli
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
J. Mitchell Harris II
Affiliation:
National Association of Children's Hospitals and Related Institutions, Alexandria, Virginia
Tom B. Rice
Affiliation:
Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
Richard J. Brilli
Affiliation:
Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
Marlene R. Miller
Affiliation:
National Association of Children's Hospitals and Related Institutions, Alexandria, Virginia Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
1500 East Medical Center Drive, Ann Arbor, MI 48109 (mniedner@med.umich.edu)
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Abstract

Objective.

Describe central line-associated bloodstream infection (CLA-BSI) epidemiology in pediatric intensive care units (PICUs).

Design.

Descriptive study (29 PICUs); cohort study (18 PICUs).

Setting.

PICUs in a national improvement collaborative.

Patients/Participants.

Patients admitted October 2006 to December 2007 with 1 or more central lines.

Methods.

CLA-BSIs were prospectively identified using the National Healthcare Safety Network definition and then readjudicated using the revised 2008 definition. Risk factors for CLA-BSI were examined using age-adjusted, time-varying Cox proportional hazards models.

Results.

In the descriptive study, the CLA-BSI incidence was 3.1/1,000 central line-days; readjudication with the revised definition resulted in a 17% decrease. In the cohort study, the readjudicated incidence was 2.0/1,000 central line-days. Ninety-nine percent of patients were CLA-BSI-free through day 7, after which the daily risk of CLA-BSI doubled to 0.27% per day. Compared with patients with respiratory diagnoses (most prevalent category), CLA-BSI risk was higher in patients with gastrointestinal diagnoses (hazard ratio [HR], 2.7 [95% confidence interval {CI}, 1.43-5.16]; P<.002) and oncologic diagnoses (HR, 2.6 [CI, 1.06-6.45]; P=.037). Among all patients, including those with more than 1 central line, CLA-BSI risk was lower among patients with a central line inserted in the jugular vein (HR, 0.43 [CI, 0.30-0.95]; P<.03).

Conclusions.

The 2008 CLA-BSI definition change decreased the measured incidence. The daily CLA-BSI risk was very low in patients during the first 7 days of catheterization but doubled thereafter. The risk of CLA-BSI was lower in patients with lines inserted in the jugular vein and higher in patients with gastrointestinal and oncologic diagnoses. These patients are target populations for additional study and intervention.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 12 , December 2011 , pp. 1200 - 1208
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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