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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 ,
Margaret Conway ,
Kathleen Wirth ,
Gail Potter-Bynoe ,
Amy L. Billett  and
Thomas J. Sandora
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
*
Department of Global Health, Children's Hospital of Philadelphia, 3535 Market Street, 13th Floor, Suite 1315, Philadelphia, PA 19104 (kellym8@email.chop.edu)
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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
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 11 , November 2011 , pp. 1079 - 1085
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR Morb Mortal Wkly Recomm Rep 2002;51(RR-10):1–29.Google Scholar
2.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
3.Biwersi, C, Hepping, N, Bode, U, et al. Bloodstream infections in a German paediatric oncology unit: prolongation of inpatient treatment and additional costs. Int J Hyg Environ Health 2009; 212:541–546.Google Scholar
4.Siempos, II, Kopterides, P, Tsangaris, I, Dimopoulou, I, Armaganidis, AE. Impact of catheter-related bloodstream infections on the mortality of critically ill patients: a meta-analysis. Crit Care Med 2009;37:2283–2289.Google Scholar
5.Elward, AM, Hollenbeak, CS, Warren, DK, Fraser, VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2005;115:868–872.CrossRefGoogle ScholarPubMed
6.Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37: 783–805.Google Scholar
7.Adler, A, Yaniv, I, Steinberg, R, et al. Infectious complications of implantable ports and Hickman catheters in paediatric haematology-oncology patients. J Hosp Infect 2006;62:358–365.Google Scholar
8.Allen, RC, Holdsworth, MT, Johnson, CA, et al. Risk determinants for catheter-associated blood stream infections in children and young adults with cancer. Pediatr Blood Cancer 2008;51:53–58.Google Scholar
9.Ross, MN, Haase, GM, Poole, MA, Burrington, JD, Odom, LF. Comparison of totally implanted reservoirs with external catheters as venous access devices in pediatric oncologic patients. Surg Gynecol Obstet 1988;167:141–144.Google ScholarPubMed
10.Smith, TL, Pullen, GT, Crouse, V, Rosenberg, J, Jarvis, WR. Bloodstream infections in pediatric oncology outpatients: a new healthcare systems challenge. Infect Control Hosp Epidemiol 2002; 23:239–243.Google Scholar
11.Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014–2020.CrossRefGoogle ScholarPubMed
12.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
13.Costello, JM, Morrow, DF, Graham, DA, et al. Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 2008; 121:915–923.Google Scholar
14.Miller, MR, Griswold, M, Harris, JM, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics 2010;125:206–213.Google Scholar
15.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;30:645–651.CrossRefGoogle ScholarPubMed
16.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.CrossRefGoogle ScholarPubMed
17.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
18.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.CrossRefGoogle ScholarPubMed
19.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
20.Ogden, CL, Kuczmarski, RJ, Flegal, KM, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002;109:45–60.CrossRefGoogle Scholar
21.Lin, MY, Hota, B, Khan, YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010;304:2035–2041.Google Scholar
22.Niedner, MF, 2008 National Association of Children's Hospitals and Related Institutions Pediatric Intensive Care Unit Patient Care Focus Group. The harder you look, the more you find: catheter-associated bloodstream infection surveillance variability. Am J Infect Control 2010;38:585–595.CrossRefGoogle ScholarPubMed
23.Fuller, AK, Uglik, KM, Savage, WJ, Ness, PM, King, KE. Bacterial culture reduces but does not eliminate the risk of septic transfusion reactions to single-donor platelets. Transfusion 2009;49: 2588–2593.Google Scholar
24.Kaplan, J, Sarnaik, S, Gidin, J, Lusher, J. Diminished helper/suppressor ratios and natural killer activity in recipients of repeated blood transfusions. Blood 1984;64:308–310.Google Scholar
25.Wood, ML, Gottschalk, R, Monaco, AP. Effect of blood transfusion on IL-2 production. Transplantation 1988;45:930–935.CrossRefGoogle ScholarPubMed
26.Waymack, JP, Gallon, L, Barcelli, U, Alexander, JW. Effect of blood transfusions on macrophage function in a burned animal model. Curr Surg 1986;43:305–307.Google Scholar
27.Aslam, R, Speck, ER, Kim, M, Freedman, J, Semple, JW. Transfusion-related immunomodulation by platelets is dependent on their expression of MHC class I molecules and is independent of white cells. Transfusion 2008;48:1778–1786.Google Scholar
28.Blumberg, N, Spinelli, SL, Francis, CW, Taubman, MB, Phipps, RP. The platelet as an immune cell: CD40 ligand and transfusion immunomodulation. Immunol Res 2009;45:251–260.CrossRefGoogle ScholarPubMed
29.Blumberg, N, Heal, JM. Effects of transfusion on immune function: cancer recurrence and infection. Arch Pathol Lab Med 1994; 118:371–379.Google Scholar
30.Houbiers, JG, van de Velde, CJ, van de Watering, LM, et al. Transfusion of red cells is associated with increased incidence of bacterial infection after colorectal surgery: a prospective study. Transfusion 1997;37:126–134.Google Scholar
31.Bodey, GP, Buckley, M, Sathe, YS, Freireich, EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966;64:328–340.CrossRefGoogle ScholarPubMed
32.Viscoli, C, Castagnola, E, Giacchino, M, et al. Bloodstream infections in children with cancer: a multicentre surveillance study of the Italian Association of Paediatric Haematology and Oncology. Eur J Cancer 1999;35:770–774.Google Scholar
33.Chathas, MK, Paton, JB, Fisher, DE. Percutaneous central venous catheterization: three years' experience in a neonatal intensive care unit. Am J Dis Child 1990;144:1246–1250.CrossRefGoogle Scholar
34.Casado-Flores, J, Valdivielso-Serna, A, Perez-Jurado, J, et al. Subclavian vein catheterization in critically ill children: analysis of 322 cannulations. Intensive Care Med 1991;17:350–354.Google Scholar
35.Abbas, AA, Fryer, CJ, Paltiel, C, et al. Factors influencing central line infections in children with acute lymphoblastic leukemia: results of a single institutional study. Pediatr Blood Cancer 2004; 42:325–331.CrossRefGoogle ScholarPubMed
36.Simon, A, Ammann, RA, Bode, U, et al. Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland. BMC Infect Dis 2008;8:70.CrossRefGoogle ScholarPubMed
37.Stamou, SC, Maltezou, HC, Pourtsidis, A, et al. Hickman-Broviac catheter-related infections in children with malignancies. Mt Sinai J Med 1999;66:320–326.Google Scholar
38.Garner, JS, Jarvis, WR, Emori, TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16: 128–140.Google Scholar
39.DiazGranados, CA, Zimmer, SM, Klein, M, Jernigan, JA. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.CrossRefGoogle ScholarPubMed
40.Butler, AM, Olsen, MA, Merz, LR, et al. Attributable costs of enterococcal bloodstream infections in a nonsurgical hospital cohort. Infect Control Hosp Epidemiol 2010;31:28–35.CrossRefGoogle Scholar