title: Microbiology and risk factors for central line-associated bloodstream infections among pediatric oncology outpatients:  a single institution experience of 41 cases.
abstract: BACKGROUND
  Risk factors for central line-associated bloodstream infections (CLABSI) among children with cancer in the outpatient setting remain poorly defined, and the microbiology may differ from hospital-onset CLABSI.
  
  
  METHODS
  We conducted a matched case-control study of oncology patients followed at the Dana Farber/Children's Hospital Cancer Center. Cases (N=41) were patients with CLABSI as per National Healthcare Safety Network criteria who had not been hospitalized in the preceding 48 hours. For each case we randomly selected 2 oncology outpatients with a central venous catheter and a clinic visit within 30 days of the case subject's CLABSI. Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI. We compared the microbiology to that of 54 hospital-onset CLABSI occurring at our institution during the study period.
  
  
  RESULTS
  Independent predictors of community-onset CLABSI included neutropenia in the prior week (odds ratio 17.46; 95% confidence interval, 4.71-64.67) and tunneled externalized catheter (vs. implantable port; odds ratio 10.30; 95% confidence interval, 2.42-43.95). Nonenteric gram-negative bacteria were more frequently isolated from CLABSI occurring among outpatients.
  
  
  CONCLUSIONS
  Pediatric oncology outpatients with recent neutropenia or tunneled externalized catheters are at increased risk of CLABSI. The microbiology of community-onset CLABSI differs from hospital-onset CLABSI.
authors: Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA. kellym8@email.chop.edu
authors: Matthew S
authors: MS
authors: Kelly
authors: Margaret
authors: M
authors: Conway
authors: Kathleen E
authors: KE
authors: Wirth
authors: Gail
authors: G
authors: Potter-Bynoe
authors: Amy L
authors: AL
authors: Billett
authors: Thomas J
authors: TJ
authors: Sandora
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000209:etiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology