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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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References

1. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP, National Nosocomial Infections Surveillance System. Nosocomial infections in pediatric intensive care units in the United States.Pediatrics. 1999;103:e39.Google Scholar
2. Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391–402.CrossRefGoogle ScholarPubMed
3. 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.Google Scholar
4. Urrea, M, Pons, M, Serra, M, Latorre, C, Palomeque, A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 2003;22:490–494.CrossRefGoogle Scholar
5. Yogaraj, JS, Elward, AM, Fraser, VJ. Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics. 2002;110:481–485.Google Scholar
6. 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; 140:432–438.CrossRefGoogle ScholarPubMed
7. Odetola, FO, Moler, FW, Dechert, RE, VanDerElzen, K, Chenoweth, C. Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 2003;4: 432–436.CrossRefGoogle Scholar
8. Wisplinghoff, H, Seifert, H, Tallent, SM, Bischoff, T, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities. Pediatr Infect Dis J 2003;22:686–691.Google Scholar
9. Aly, H, Herson, V, Duncan, A, et al. Is bloodstream infection preventable among premature infants? a tale of two cities. Pediatrics 2005;115:1513–1518.Google Scholar
10. 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.Google Scholar
11. Costello, JM, Morrow, DF, 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
12. Nowak, JE, Brilli, RJ, Lake, MR, et al. Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: business case for quality improvement. Pediatr Crit Care Med 2010; 11:579–587.Google Scholar
13. 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
14. National Nosocomial Infections Surveillance (NNIS) system report, data summary from October 1986-April 1998, issued June 1998. Am J Infect Control 1998;26:522–533.CrossRefGoogle Scholar
15. Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60: 243–248.Google Scholar
16. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.Google Scholar
17. Elward, AM, Fraser, VJ. 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.Google Scholar
18. Kritchevsky, SB, Braun, BI, Kusek, L, et al. The impact of hospital practice on central venous catheter associated bloodstream infection rates at the patient and unit level: a multicenter study. Am J Med Qual 2008;23:24–38.Google Scholar
19. Almuneef, MA, Memish, ZA, Balkhy, HH, Hijazi, O, Cunningham, G, Francis, C. Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006;62:207–213.CrossRefGoogle Scholar
20. Safdar, N, Kluger, DM, Maki, DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore) 2002;81:466–479.Google Scholar
21. Miller, MR, Griswold, M, Harris, GM II, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics. 2010;125:206–213.Google Scholar
22. VPS. Virtual PICU Performance System. Alexandria, VA: VPS, 2011. https://portal.myvps.org/Default.aspx.Google Scholar
23. Centers for Disease Control and Prevention. Central Line-Associated Bloodstream Infection (CLABSI) Event: Guidelines and Procedures for Monitoring CLABSI. National Healthcare Safety Network (NHSN) manual. Atlanta, GA: NHSN, 2010. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf.Google Scholar
24. Centers for Disease Control and Prevention. Catheter-Associated Bloodstream Infection Definitions. National Healthcare Safety Network (NHSN) manual. Alanta, GA: NHSN, 2008. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf.Google Scholar
25. Garcia, PC, Piva, JP. Pediatric Index of Mortality 2 (PIM2)—a prognostic tool for developing countries: easy, efficient, and free! Pediatr Crit Care Med 2007;8:77–78.Google Scholar
26. 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.Google Scholar
27. 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.Google Scholar
28. Ullman, RF, Gurevich, I, Schoch, PE, Cunha, BA. Colonization and bacteremia related to duration of triple-lumen intravascular catheter placement. Am J Infect Control 1990;18:201–207.Google Scholar
29. O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.Google Scholar
30. Eyer, S, Brummitt, C, Crossley, K, Siegel, R, Cerra, F. Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance. Crit Care Med 1990;18: 1073–1079.Google Scholar
31. Cobb, DK, High, KP, Sawyer, RG, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:1062–1068.Google Scholar
32. Stenzel, JP, Green, TP, Fuhrman, BP, Carlson, PE, Marchessault, RP. Percutaneous central venous catheterization in a pediatric intensive care unit: a survival analysis of complications. Crit Care Med 1989;17:984–988.CrossRefGoogle Scholar
33. Wylie, MC, Graham, DA, Potter-Bynoe, G, et al. Risk factors for central line-associated bloodstream infection in pediatric intensive care units. Infect Control Hosp Epidemiol 2010;31:1049–1056.Google Scholar
34. Al-Rawajfah, OM, Stetzer, F, Hewitt, JB. Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. Infect Control Hosp Epidemiol 2009;30: 1036–1044.Google Scholar
35. Wiest, R, Rath, HC. Gastrointestinal disorders of the critically ill: bacterial translocation in the gut. Best Pract Res Clin Gastroenterol 2003;17:397–425.Google Scholar
36. 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
37. Simon, A, Fleischhack, G, Hasan, C, Bode, U, Engelhart, S, Kramer, MH. Surveillance for nosocomial and central line-related infections among pediatric hematology-oncology patients. Infect Control Hosp Epidemiol 2000;21:592–596.Google Scholar
38. Edwards, JR, Peterson, KD, Andrus, ML, et al. National Healthcare Safety Network (NHSN) report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290–301.Google Scholar
39. 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.Google Scholar
40. Rothman, KJ, Greenland, S, Lash, TL. Validity in epidemiologic studies. In: Rothman, KJ, Greenland, S, Lash, TL, eds. Modern Epidemiology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2008:128–147.Google Scholar
41. Niedner, MF. The harder you look, the more you find: catheter-associated bloodstream infection surveillance variability. Am J Infect Control 2010;38:585–595.Google Scholar