title: Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: risk and rates associated with various intravascular technologies.
abstract: OBJECTIVE
  Nosocomial bloodstream infections are associated with increased patient morbidity, mortality, and hospital costs. More than 90% of these infections are related to the use of intravascular catheter devices. This study was done to assess the risk and rates of catheter related-bloodstream infections (CR-BSI) associated with different intravascular technologies in a pediatric intensive care unit population.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A 16-bed pediatric intensive care unit in a tertiary children's hospital.
  
  
  METHODS
  All admissions between July 1997 and December 1999 requiring placement of an intravascular access device for care were examined. Patients with CR-BSI were identified through ongoing surveillance using Centers for Disease Control/National Nosocomial Infections Surveillance System definitions for bloodstream infection.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 2,728 admissions during the review period, 1,043 (38.3%) required placement of an intravascular access device. Bivariate analysis revealed that patients who required intravascular cannulae for extracorporeal life support had a 10-fold increased risk of developing a CR-BSI, and patients requiring vascular access for renal replacement therapy demonstrated a 4-fold increase in the risk of developing CR-BSI compared with the referent group. There was a significant increase in the CR-BSI rate associated with the use of more intravascular access devices per patient admission. Multivariate logistic regression identified the use of extracorporeal life support therapy and the total duration of use of intravascular access devices as significant independent predictors of CR-BSI when controlling for other predictors.
  
  
  CONCLUSIONS
  The use of extracorporeal life support therapy, the presence of multiple intravascular access devices, and the total duration of intravascular access device use were associated with an increase in the rate and risk of developing CR-BSI in our pediatric intensive care unit population. Larger, prospective studies may help elucidate additional factors responsible for these observations.
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
authors.forename: Frank W
authors.initials: FW
authors.lastname: Moler
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Dechert
authors.forename: Kristen
authors.initials: K
authors.lastname: VanDerElzen
authors.forename: Carol
authors.initials: C
authors.lastname: Chenoweth
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000295:instrumentation; D012189:Retrospective Studies; D018570:Risk Assessment