title: Polymicrobial bloodstream infections among children and adolescents with central venous catheters evaluated in ambulatory care.
abstract: BACKGROUND
  Bloodstream infections (BSIs) are an ever-present concern for clinicians evaluating ill-appearing pediatric patients with central venous catheters (CVCs) in the ambulatory care setting.
  
  
  METHODS
  We performed a case-control study of a cohort of 200 pediatric patients who were evaluated in the ambulatory care setting and who were found to have laboratory-confirmed BSI in the context of a CVC. This study sought to compare patients with polymicrobial versus monomicrobial BSIs to identify potential risk factors for polymicrobial BSI.
  
  
  RESULTS
  Of the 200 patients enrolled in the study, 73 (37%) had a polymicrobial BSI. Patients with polymicrobial BSI were more likely than those with monomicrobial BSI to be younger (P=.002) and less likely to have been recently discharged from the hospital (P=.01). The odds of a polymicrobial BSI were >4 times greater for patients aged <3 years than for those aged >or=3 years (odds ratio, 4.54; 95% confidence interval, 1.68-12.29), and the odds were 50% lower for those discharged from the hospital in the prior 7 days than for those without recent hospitalization (odds ratio, 0.46; 95% confidence interval, 0.22-0.95) after controlling for an underlying cancer diagnosis and the time of year during which a patient presented. Recent antibiotic use, recent BSI, duration that the CVC had been in place, and underlying gastrointestinal dysfunction were not associated with a risk of polymicrobial BSI.
  
  
  CONCLUSIONS
  Younger children and those who had not recently been discharged from the hospital had an increased risk of developing catheter-related polymicrobial BSI. Special consideration should be given to the increased likelihood of polymicrobial BSIs in these pediatric patients when initiating empirical antimicrobial therapy.
authors.affiliation: Divisions of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Downes
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
authors.forename: Karin L
authors.initials: KL
authors.lastname: McGowan
authors.forename: Michael R
authors.initials: MR
authors.lastname: Elliott
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004866:Equipment Contamination; D005260:Female; D006088:Gram-Negative Aerobic Bacteria / Q000302:isolation & purification; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors