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Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit

Costello, John M. MD, MPH; Graham, Dionne A. PhD; Morrow, Debra Forbes BSN; Potter-Bynoe, Gail BS, CIC; Sandora, Thomas J. MD, MPH; Laussen, Peter C. MBBS

Pediatric Critical Care Medicine: July 2009 - Volume 10 - Issue 4 - pp 453-459
doi: 10.1097/PCC.0b013e318198b19a
Cardiac Intensive Care

Objective: To identify risk factors for central line-associated bloodstream infection (BSI) in patients receiving care in a pediatric cardiac intensive care unit.

Design: Matched case-control study.

Setting: CICU at Children's Hospital Boston.

Patients: Central line-associated BSI cases were identified between April 2004 and December 2006. We identified two randomly selected control patients who had a central vascular catheter and were admitted within 7 days of each index case.

Measurements and Main Results: Univariate and multivariate conditional logistic regression analyses were used to identify risk factors for central line-associated BSI. In a secondary analysis, risk factors for central line-associated BSI in those cases who underwent cardiac surgery were sought. During the study period, 67 central line-associated BSIs occurred in 61 patients. Independent risk factors for central line-associated BSI were nonelective admission for medical management (odds ratio [OR] = 6.51 [1.58–26.78]), the presence of noncardiac comorbidities (OR = 4.95 [1.49–16.49]), initial absolute neutrophil count <5000 cells/uL (OR = 6.17 [1.39–27.48]), blood product exposure ≥3 units (OR = 5.56 [1.35–22.87]), central line days ≥7 (OR = 6.06 [1.65–21.83]), and use of hydrocortisone (OR = 28.94 [2.55–330.37]). In those patients who underwent cardiac surgery (n = 37 cases and 108 controls), independent risk factors for central line-associated BSI were admission weight ≤5 kg (OR = 3.13 [1.01–9.68]), Pediatric Risk of Mortality III score ≥15 (OR = 3.44 [1.19–9.92]), blood product exposure ≥3 units (OR = 3.38 [1.28–11.76]), and mechanical ventilation for ≥7 days (OR = 4.06 [1.33–12.40]).

Conclusions: Unscheduled medical admissions, presence of noncardiac comorbidities, extended device utilization, and specific medical therapies are independent risk factors for central line-associated BSI in patients receiving care in a pediatric cardiac intensive care unit.

From the Departments of Cardiology (JMC, DAG, PCL), Nursing (DFM), and Laboratory Medicine (TJS); Clinical Research Program (DAG); Infection Control Program (GP-B, TJS); and Division of Infectious Diseases (TJS), Children's Hospital Boston, Harvard Medical School, Boston, MA.

Supported, in part, through the Bertelson Critical Care Research Endowment Fund, and the Children's Hospital Boston Program for Patient Safety and Quality.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: john.costello@cardio.chboston.org

©2009The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies