Moving CLABSI prevention beyond the intensive care unit: risk factors in pediatric oncology patients.
OBJECTIVE
Central line-associated bloodstream infections (CLABSIs) frequently complicate the use of central venous catheters (CVCs) among pediatric patients with cancer. Our objectives were to describe the microbiology and identify risk factors for hospital-onset CLABSI in this patient population.


METHODS
Retrospective case-control study.


METHODS
Oncology and stem cell transplant units of a freestanding, 396-bed quaternary care pediatric hospital.


METHODS
Case subjects ([Formula: see text]) were patients with a diagnosis of malignancy and/or stem cell transplant recipients with CLABSI occurring during admission. Controls ([Formula: see text]) were identified using risk set sampling of hospitalizations among patients with a CVC, matched on date of admission.


METHODS
Multivariate conditional logistic regression was used to identify independent predictors of CLABSI.


RESULTS
The majority of CLABSI isolates were gram-positive bacteria (58%). The most frequently isolated organism was Enterococcus faecium, and 6 of 9 isolates were resistant to vancomycin. In multivariate analyses, independent risk factors for CLABSI included platelet transfusion within the prior week (odds ratio [OR], 10.90 [95% confidence interval (CI), 3.02-39.38]; [Formula: see text]) and CVC placement within the previous month (<1 week vs ≥1 month: OR, 11.71 [95% CI, 1.98-69.20]; [Formula: see text]; ≥1 week and <1 month vs ≥1 month: OR, 7.37 [95% CI, 1.85-29.36]; [Formula: see text]).


CONCLUSIONS
Adjunctive measures to prevent CLABSI among pediatric oncology patients may be most beneficial in the month following CVC insertion and in patients requiring frequent platelet transfusions. Vancomycin-resistant enterococci may be an emerging cause of CLABSI in hospitalized pediatric oncology patients and are unlikely to be treated by typical empiric antimicrobial regimens.
Department of Medicine, Children's Hospital Boston, Boston, Massachusetts, USA. kellym8@email.chop.edu
Matthew
M
Kelly
Margaret
M
Conway
Kathleen
K
Wirth
Gail
G
Potter-Bynoe
Amy L
AL
Billett
Thomas J
TJ
Sandora
D000293:Adolescent; D000328:Adult; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016984:Enterococcus faecium; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016522:Oncology Service, Hospital; D017713:Platelet Transfusion; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013997:Time Factors; D020713:Vancomycin Resistance; D055815:Young Adult