Conflict of interest: Dr. Milstone received grant support from Sage Products, Inc. This sponsor had no role in study design, data collection, analysis or interpretation of data, writing of the report or the decision to submit the manuscript. No other authors have any relevant conflicts of interest with the manuscript.
Ambulatory pediatric oncology CLABSIs: Epidemiology and risk factors
Article first published online: 23 JUL 2013
Copyright © 2013 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 60, Issue 11, pages 1882–1889, November 2013
How to Cite
Rinke, M. L., Milstone, A. M., Chen, A. R., Mirski, K., Bundy, D. G., Colantuoni, E., Pehar, M., Herpst, C. and Miller, M. R. (2013), Ambulatory pediatric oncology CLABSIs: Epidemiology and risk factors. Pediatr. Blood Cancer, 60: 1882–1889. doi: 10.1002/pbc.24677
- Issue published online: 11 SEP 2013
- Article first published online: 23 JUL 2013
- Manuscript Accepted: 6 JUN 2013
- Manuscript Received: 4 JAN 2013
- National Center for Research Resources. Grant Number: 5KL2RR025006
- Agency for Healthcare Research and Quality. Grant Number: K08HS021282
- central line-associated blood stream infection;
- central venous catheter/access device;
- outpatient management;
- quality improvement
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.
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.
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).
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. Pediatr Blood Cancer 2013;60:1882–1889. © 2013 Wiley Periodicals, Inc.