Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit

Matthew F. Niedner, W Charles Huskins, Elizabeth Colantuoni, John Muschelli, J. Mitchell Harris, Tom B. Rice, Richard J. Brilli, Marlene R. Miller

Research output: Contribution to journalArticle

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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 Health care 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 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. The2008CLA-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.

Original languageEnglish (US)
Pages (from-to)1200-1208
Number of pages9
JournalInfection Control and Hospital Epidemiology
Volume32
Issue number12
DOIs
StatePublished - Dec 2011

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Pediatric Intensive Care Units
Epidemiology
Infection
Jugular Veins
Confidence Intervals
Incidence
Cohort Studies
Health Services Needs and Demand
Proportional Hazards Models
Catheterization

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

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Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. / Niedner, Matthew F.; Huskins, W Charles; Colantuoni, Elizabeth; Muschelli, John; Harris, J. Mitchell; Rice, Tom B.; Brilli, Richard J.; Miller, Marlene R.

In: Infection Control and Hospital Epidemiology, Vol. 32, No. 12, 12.2011, p. 1200-1208.

Research output: Contribution to journalArticle

Niedner, MF, Huskins, WC, Colantuoni, E, Muschelli, J, Harris, JM, Rice, TB, Brilli, RJ & Miller, MR 2011, 'Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit', Infection Control and Hospital Epidemiology, vol. 32, no. 12, pp. 1200-1208. https://doi.org/10.1086/662621
Niedner, Matthew F. ; Huskins, W Charles ; Colantuoni, Elizabeth ; Muschelli, John ; Harris, J. Mitchell ; Rice, Tom B. ; Brilli, Richard J. ; Miller, Marlene R. / Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. In: Infection Control and Hospital Epidemiology. 2011 ; Vol. 32, No. 12. pp. 1200-1208.
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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 Health care 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 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. The2008CLA-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.",
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AU - Harris, J. Mitchell

AU - Rice, Tom B.

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