title: A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients.
abstract: OBJECTIVE To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate DESIGN Prospective cohort study SETTING US multicenter, quality-improvement, BSI prevention network PARTICIPANTS PHO centers across the United States who agreed to follow a standardized central-line-maintenance care bundle and track all BSI events and central-line days every month. METHODS Infections were categorized as CLABSI (stratified by mucosal barrier injury-related, laboratory-confirmed BSI [MBI-LCBI] versus non-MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked. RESULTS Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P<.001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates. CONCLUSIONS Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. Infect Control Hosp Epidemiol 2017;38:690-696.
authors.affiliation: 1St Jude Children's Research Hospital,Memphis,Tennessee.
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.affiliation: 2Medical University of South Carolina,Charleston,South Carolina.
authors.forename: David G
authors.initials: DG
authors.lastname: Bundy
authors.affiliation: 3Children's Specialty Group,Norfolk,Virginia.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Werner
authors.affiliation: 4Akron Children's Hospital,Akron,Ohio.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Hord
authors.affiliation: 5Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
authors.affiliation: 1St Jude Children's Research Hospital,Memphis,Tennessee.
authors.forename: Li
authors.initials: L
authors.lastname: Tang
authors.affiliation: 6Children's Hospital Association,Washington,DC.
authors.forename: John P
authors.initials: JP
authors.lastname: Lawlor
authors.affiliation: 7Dana-Farber/Boston Children's Cancer and Blood Disorders Center,Boston,Massachusetts.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Billett
mesh_terms: D000071997:Blood Culture; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology*; D019337:Hematologic Neoplasms / Q000150:complications*; D006405:Hematology / Q000706:statistics & numerical data; D006694:Holistic Health; D006757:Hospital Units / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D009503:Neutropenia / Q000150:complications; D064872:Patient Care Bundles; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D058996:Quality Improvement; D018805:Sepsis / Q000453:epidemiology*; D009626:Terminology as Topic; D014481:United States