title: Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit.
abstract: OBJECTIVE
  Describe central line-associated bloodstream infection (CLA-BSI) epidemiology in pediatric intensive care units (PICUs).
  
  
  METHODS
  Descriptive study (29 PICUs); cohort study (18 PICUs).
  
  
  METHODS
  PICUs in a national improvement collaborative.
  
  
  METHODS
  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.
authors.affiliation: Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA. mniedner@med.umich.edu
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Niedner
authors.forename: W Charles
authors.initials: WC
authors.lastname: Huskins
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: John
authors.initials: J
authors.lastname: Muschelli
authors.forename: J Mitchell
authors.initials: JM
authors.lastname: Harris
authors.forename: Tom B
authors.initials: TB
authors.lastname: Rice
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D017848:Blood-Borne Pathogens / Q000302:isolation & purification; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D016208:Databases, Factual; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009181:Mycoses / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology