BACKGROUND: To compare the burden of central line-associated bloodstream infections (CLABSIs) in ambulatory versus inpatient pediatric oncology patients, and identify the epidemiology of and risk factors associated with ambulatory CLABSIs. PROCEDURE: We prospectively identified infections and retrospectively identified central line days and characteristics associated with CLABSIs from January 2009 to October 2010. A nested case-control design was used to identify characteristics associated with ambulatory CLABSIs. RESULTS: We identified 319 patients with central lines. There were 55 ambulatory CLABSIs during 84,705 ambulatory central line days (0.65 CLABSIs per 1,000 central line days (95% CI 0.49, 0.85)), and 19 inpatient CLABSIs during 8,682 inpatient central line days (2.2 CLABSIs per 1,000 central lines days (95% CI 1.3, 3.4)). In patients with ambulatory CLABSIs, 13% were admitted to an intensive care unit and 44% had their central lines removed due to the CLABSI. A secondary analysis with a sub-cohort, suggested children with tunneled, externalized catheters had a greater risk of ambulatory CLABSI than those with totally implantable devices (IRR 20.6, P < 0.001). Other characteristics independently associated with ambulatory CLABSIs included bone marrow transplantation within 100 days (OR 16, 95% CI 1.1, 264), previous bacteremia in any central line (OR 10, 95% CI 2.5, 43) and less than 1 month from central line insertion (OR 4.2, 95% CI 1.0, 17). CONCLUSIONS: In pediatric oncology patients, three times more CLABSIs occur in the ambulatory than inpatient setting. Ambulatory CLABSIs carry appreciable morbidity and have identifiable, associated factors that should be addressed in future ambulatory CLABSI prevention efforts.
BACKGROUND: To compare the burden of central line-associated bloodstream infections (CLABSIs) in ambulatory versus inpatient pediatric oncology patients, and identify the epidemiology of and risk factors associated with ambulatory CLABSIs. PROCEDURE: We prospectively identified infections and retrospectively identified central line days and characteristics associated with CLABSIs from January 2009 to October 2010. A nested case-control design was used to identify characteristics associated with ambulatory CLABSIs. RESULTS: We identified 319 patients with central lines. There were 55 ambulatory CLABSIs during 84,705 ambulatory central line days (0.65 CLABSIs per 1,000 central line days (95% CI 0.49, 0.85)), and 19 inpatient CLABSIs during 8,682 inpatient central line days (2.2 CLABSIs per 1,000 central lines days (95% CI 1.3, 3.4)). In patients with ambulatory CLABSIs, 13% were admitted to an intensive care unit and 44% had their central lines removed due to the CLABSI. A secondary analysis with a sub-cohort, suggested children with tunneled, externalized catheters had a greater risk of ambulatory CLABSI than those with totally implantable devices (IRR 20.6, P < 0.001). Other characteristics independently associated with ambulatory CLABSIs included bone marrow transplantation within 100 days (OR 16, 95% CI 1.1, 264), previous bacteremia in any central line (OR 10, 95% CI 2.5, 43) and less than 1 month from central line insertion (OR 4.2, 95% CI 1.0, 17). CONCLUSIONS: In pediatric oncology patients, three times more CLABSIs occur in the ambulatory than inpatient setting. Ambulatory CLABSIs carry appreciable morbidity and have identifiable, associated factors that should be addressed in future ambulatory CLABSI prevention efforts.
Authors: Jonathan R Edwards; Kelly D Peterson; Yi Mu; Shailendra Banerjee; Katherine Allen-Bridson; Gloria Morrell; Margaret A Dudeck; Daniel A Pollock; Teresa C Horan Journal: Am J Infect Control Date: 2009-12 Impact factor: 2.918
Authors: David K Warren; Wasim W Quadir; Christopher S Hollenbeak; Alexis M Elward; Michael J Cox; Victoria J Fraser Journal: Crit Care Med Date: 2006-08 Impact factor: 7.598
Authors: Kevin J Downes; Joshua P Metlay; Louis M Bell; Karin L McGowan; Michael R Elliott; Samir S Shah Journal: Clin Infect Dis Date: 2008-02-01 Impact factor: 9.079
Authors: Rebekah C Allen; Mark T Holdsworth; Cynthia A Johnson; Cathy M Chavez; Richard L Heideman; Gary Overturf; David Lemon; W Curtis Hunt; Stuart S Winter Journal: Pediatr Blood Cancer Date: 2008-07 Impact factor: 3.167
Authors: Sara C Keller; Deborah Williams; Clare Rock; Shiv Deol; Polly Trexler; Sara E Cosgrove Journal: Am J Infect Control Date: 2018-06-13 Impact factor: 2.918
Authors: Michael L Rinke; Allen R Chen; Aaron M Milstone; Lindsay C Hebert; David G Bundy; Elizabeth Colantuoni; Lisa Fratino; Cynthia Herpst; Michelle Kokoszka; Marlene R Miller Journal: Jt Comm J Qual Patient Saf Date: 2015-04
Authors: Steven S Spires; Peter F Rebeiro; Mickie Miller; Katie Koss; Patty W Wright; Thomas R Talbot Journal: Infect Control Hosp Epidemiol Date: 2018-02-15 Impact factor: 3.254
Authors: Sara C Keller; Deborah Williams; Mitra Gavgani; David Hirsch; John Adamovich; Dawn Hohl; Amanda Krosche; Sara Cosgrove; Trish M Perl Journal: Infect Control Hosp Epidemiol Date: 2016-10-04 Impact factor: 3.254
Authors: Melissa A Shenep; Mary R Tanner; Yilun Sun; Tina Culley; Randall T Hayden; Patricia M Flynn; Li Tang; Joshua Wolf Journal: JPEN J Parenter Enteral Nutr Date: 2016-01-07 Impact factor: 4.016
Authors: Michael L Rinke; David G Bundy; Allen R Chen; Aaron M Milstone; Elizabeth Colantuoni; Miriana Pehar; Cynthia Herpst; Lisa Fratino; Marlene R Miller Journal: Pediatrics Date: 2013-10-07 Impact factor: 7.124
Authors: Aaron M Milstone; Carol Rosenberg; Gayane Yenokyan; Danielle W Koontz; Marlene R Miller Journal: Infect Control Hosp Epidemiol Date: 2020-10-12 Impact factor: 3.254
Authors: Laura M Figueroa-Phillips; Christopher P Bonafide; Susan E Coffin; Michelle E Ross; James P Guevara Journal: Pediatr Emerg Care Date: 2020-11 Impact factor: 1.602