title: Risk factors for catheter-associated bloodstream infections in a Pediatric Cardiac Intensive Care Unit.
abstract: BACKGROUND
  Catheter-associated bloodstream infections (CA-BSIs) are an important complication of care in children hospitalized with complex congenital heart disease; however, little is known about risk factors for CA-BSI in these patients.
  
  
  METHODS
  We conducted a retrospective nested case-control study in the 26-bed Cardiac Intensive Care Unit (CICU) at the Children's Hospital of Philadelphia.We identified all primary CA-BSIs in the CICU between January 1, 2004 and June 30, 2005. Controls were selected from rosters of CICU patients that were admitted during the same time period. Incidence density sampling was used to match cases and controls on time at risk. Data on demographic features and clinical characteristics were abstracted from the medical record. In addition, detailed data on exposures to medical devices, interventions, and therapeutic agents were gathered during a 4-day period immediately before the onset of infection (cases) or study entry (controls).
  
  
  RESULTS
  We identified 59 children who developed a CA-BSI. The median time from catheter insertion to onset of infection was 9 days. Over half of infections were caused by gram positive organisms. On multivariable analysis, only tunneled catheters emerged as an independent risk factor for infection.
  
  
  CONCLUSIONS
  In this study population, tunneled catheters were associated with a higher risk of CA-BSI, possibly because of the catheter material. Additionally, we did not find that the burden of catheters and medical devices was associated with an increased risk of infection. Because most CA-BSIs in our study population occurred > or =7 days after catheter insertion, strict attention to aseptic technique when using or dressing a catheter might reduce CA-BSI rates in the pediatric CICU.
authors: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: Priya A
authors: PA
authors: Prasad
authors: Troy E
authors: TE
authors: Dominguez
authors: Theoklis E
authors: TE
authors: Zaoutis
authors: Samir S
authors: SS
authors: Shah
authors: Eva
authors: E
authors: Teszner
authors: J  William
authors: J
authors: Gaynor
authors: Sarah
authors: S
authors: Tabbutt
authors: Susan E
authors: SE
authors: Coffin
mesh_terms: D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors