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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Pediatric Ambulatory Central Line–Associated Bloodstream Infections

Michael L. Rinke, Moonseong Heo, Lisa Saiman, David G. Bundy, Rebecca E. Rosenberg, Patricia DeLaMora, Barbara Rabin, Philip Zachariah, Parsa Mirhaji, William J. H. Ford, Oghale Obaro-Best, Michael Drasher, Elizabeth Klein, Alexandre Peshansky and Suzette O. Oyeku
Pediatrics January 2021, 147 (1) e20200524; DOI: https://doi.org/10.1542/peds.2020-0524
Michael L. Rinke
aThe Children’s Hospital at Montefiore, Bronx, New York;
bAlbert Einstein College of Medicine, Bronx, New York;
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Moonseong Heo
cDepartment of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina;
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Lisa Saiman
dColumbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York;
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David G. Bundy
eDepartment of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina;
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Rebecca E. Rosenberg
fDepartment of Pediatrics, School of Medicine, New York University, New York, New York;
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Patricia DeLaMora
gDepartment of Pediatrics, Weill Cornell Medical College, New York, New York;
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Barbara Rabin
hDepartment of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York;
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Philip Zachariah
dColumbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York;
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Parsa Mirhaji
bAlbert Einstein College of Medicine, Bronx, New York;
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William J. H. Ford
fDepartment of Pediatrics, School of Medicine, New York University, New York, New York;
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Oghale Obaro-Best
iDepartment of Medicine, State University of New York Upstate Medical University, Syracuse, New York; and
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Michael Drasher
jSchool of Medicine, Wayne State University, Detroit, Michigan
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Elizabeth Klein
bAlbert Einstein College of Medicine, Bronx, New York;
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Alexandre Peshansky
bAlbert Einstein College of Medicine, Bronx, New York;
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Suzette O. Oyeku
aThe Children’s Hospital at Montefiore, Bronx, New York;
bAlbert Einstein College of Medicine, Bronx, New York;
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Abstract

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BACKGROUND: Inpatient pediatric central line–associated bloodstream infections (CLABSIs) cause morbidity and increased health care use. Minimal information exists for ambulatory CLABSIs despite ambulatory central line (CL) use in children. In this study, we identified ambulatory pediatric CLABSI incidence density, risk factors, and outcomes.

METHODS: Retrospective cohort with nested case-control study at 5 sites from 2010 through 2015. Electronic queries were used to identify potential cases on the basis of administrative and laboratory data. Chart review was used to confirm ambulatory CL use and adjudicated CLABSIs. Bivariate followed by multivariable backward logistic regression was used to identify ambulatory CLABSI risk factors.

RESULTS: Queries identified 4600 potentially at-risk children; 1658 (36%) had ambulatory CLs. In total, 247 (15%) patients experienced 466 ambulatory CLABSIs with an incidence density of 0.97 CLABSIs per 1000 CL days. Incidence density was highest among patients with tunneled externalized catheters versus peripherally inserted central catheters and totally implanted devices: 2.58 CLABSIs per 1000 CL days versus 1.46 vs 0.23, respectively (P < .001). In a multivariable model, clinic visit (odds ratio [OR] 2.8; 95% confidence interval [CI]: 1.4–5.5) and low albumin (OR 2.3; 95% CI: 1.2–4.3) were positively associated with CLABSI, and prophylactic antimicrobial agents for underlying conditions within the preceding 30 days (OR 0.22; 95% CI: 0.12–0.40) and operating room CL placement (OR 0.36; 95% CI: 0.16–0.79) were inversely associated with CLABSI. A total of 396 patients (85%) were hospitalized because of ambulatory CLABSI with an 8-day median length of stay (interquartile range 5–13).

CONCLUSIONS: Ambulatory pediatric CLABSI incidence density is appreciable and associated with health care use. CL type, patients with low albumin, prophylactic antimicrobial agents, and placement setting may be targets for reduction efforts.

  • Accepted October 6, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Vol. 147, Issue 1
1 Jan 2021
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Pediatric Ambulatory Central Line–Associated Bloodstream Infections
Michael L. Rinke, Moonseong Heo, Lisa Saiman, David G. Bundy, Rebecca E. Rosenberg, Patricia DeLaMora, Barbara Rabin, Philip Zachariah, Parsa Mirhaji, William J. H. Ford, Oghale Obaro-Best, Michael Drasher, Elizabeth Klein, Alexandre Peshansky, Suzette O. Oyeku
Pediatrics Jan 2021, 147 (1) e20200524; DOI: 10.1542/peds.2020-0524

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Pediatric Ambulatory Central Line–Associated Bloodstream Infections
Michael L. Rinke, Moonseong Heo, Lisa Saiman, David G. Bundy, Rebecca E. Rosenberg, Patricia DeLaMora, Barbara Rabin, Philip Zachariah, Parsa Mirhaji, William J. H. Ford, Oghale Obaro-Best, Michael Drasher, Elizabeth Klein, Alexandre Peshansky, Suzette O. Oyeku
Pediatrics Jan 2021, 147 (1) e20200524; DOI: 10.1542/peds.2020-0524
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