Background: Catheter-associated bloodstream infections (CA-BSIs) are an important complication of care in children hospitalized with complex congenital heart disease; however, little is known about risk factors for CA-BSI in these patients.
Methods: We conducted a retrospective nested case-control study in the 26-bed Cardiac Intensive Care Unit (CICU) at the Children's Hospital of Philadelphia. We identified all primary CA-BSIs in the CICU between January 1, 2004 and June 30, 2005. Controls were selected from rosters of CICU patients that were admitted during the same time period. Incidence density sampling was used to match cases and controls on time at risk. Data on demographic features and clinical characteristics were abstracted from the medical record. In addition, detailed data on exposures to medical devices, interventions, and therapeutic agents were gathered during a 4-day period immediately before the onset of infection (cases) or study entry (controls).
Results: We identified 59 children who developed a CA-BSI. The median time from catheter insertion to onset of infection was 9 days. Over half of infections were caused by gram positive organisms. On multivariable analysis, only tunneled catheters emerged as an independent risk factor for infection.
Conclusion: In this study population, tunneled catheters were associated with a higher risk of CA-BSI, possibly because of the catheter material. Additionally, we did not find that the burden of catheters and medical devices was associated with an increased risk of infection. Because most CA-BSIs in our study population occurred ≥7 days after catheter insertion, strict attention to aseptic technique when using or dressing a catheter might reduce CA-BSI rates in the pediatric CICU.
From the *Division of Infectious Diseases, and †Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; ‡The University of Pennsylvania School of Medicine, Philadelphia, PA; §Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; and Departments of ¶Infection Control and ∥Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Accepted for publication February 25, 2010.
All work was performed at The Children's Hospital of Philadelphia, Philadelphia, PA.
Funding for this study was obtained from the Department of Anesthesia and Critical Care Medicine and the Division of Infectious Diseases at the Children's Hospital of Philadelphia.
Presented in part at the Society for Healthcare Epidemiology of America Annual Meeting in Orlando, FL in April 2008.
Address for correspondence: Susan E. Coffin, MD, MPH, Children's Hospital of Philadelphia, Room AE17, 34th and Civic Center Blvd., Philadelphia, PA 19104. E-mail: firstname.lastname@example.org.
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