Background: Central line-associated bloodstream infections (CLABSIs) are among the most common complications of central venous catheters (CVCs) which account for significant morbidity and mortality, prolonged hospitalization, and increased hospital costs.
Objectives: To examine the incidence and risk factors, and assess the treatment outcomes of newborns and children with CLABSI admitted to a tertiary care hospital.
Method: A retrospective cohort study was conducted. Participants aged <18 years who had at least one CVC, and admitted to Chiang Mai University Hospital during September 2016 to September 2018 were enrolled. Clinical characteristics, CVC-related information, CLABSI information, and treatment outcomes of study participants were reviewed. CLABSI was defined as a laboratory confirmed BSI with a present of an eligible BSI organism and an eligible CVC. Incidence rate (per 1,000 catheter-days) of CLABSI was calculated by age group (newborns [aged<1month]; and children). Poisson regression analysis was performed to identify risk factors of CLABSI among these two populations.
Results: Of 1,048 enrolled participants, 443 (42%) were newborns, and 605 (58%) were children. Among newborns, 73% had neonatal conditions as a primary disease. The most common CVC type, number of lumen, inserter, and insertion area were umbilical catheter (50%), single-lumen (73%), fellow/resident (80%), and NICU/NCCU (80%), respectively. The median duration of CVC placement was 6 (IQR: 4-10) days. Among children, 97% had medical conditions as a primary disease. The most common CVC type, number of lumen, insertion vessel, inserter, and insertion area were short-term, non-tunneled (97%), triple-lumen (91%), internal jugular/subclavian vein (67%), anesthesiologist/surgeon (55%), and operating room (57%), respectively. The median CVC placement duration was 6 (IQR: 2-11) days.
Over study period, 30 CLABSIs (2.9%) were identified, accounting for the overall incidence rate of 3.2 per 1,000 catheter-days (95%CI: 2.3-4.6), which was not different between age groups (newborn: 3.1 vs. children: 3.3; P=0.85). Triple-lumen catheter increased risk of CLABSI in newborns (adjusted odds ratio[aOR]: 8.3; 95%CI: 1.3-53.8, compared with single-lumen catheter), whereas inserting CVC in PICU/PCICU decreased risk among children (aOR: 0.2; 95%CI: 0.04-0.8, compared with general ward). There were 131 deaths (13%; 64 newborns, 67 children); of which 3 (2%) (1 newborn, 2 children) were related to CLABSIs. The overall mortality was not different between those with vs. without CLABSI in both age groups (P>0.05). The length of hospital stay (61 vs. 16 days; P<0.001) and medication costs (1,321 vs. 716 USD; P=0.003) were increased in children with CLABSI, but not for newborns (P>0.05).
Conclusion: High incidence rate of CLABSIs was observed in our setting. Although the mortality was not increased, this CVC complication resulted in prolonged hospitalization, and increased hospital costs in our children.
Keywords: Central-line associated bloodstream infections, central venous catheterization, children, hospital costs, length of hospitalization, newborns, treatment outcomes.
