Ambulatory pediatric oncology CLABSIs: Epidemiology and risk factors

Michael L. Rinke, Aaron M. Milstone, Allen R. Chen, Kara Mirski, David G. Bundy, Elizabeth Colantuoni, Miriana Pehar, Cynthia Herpst, Marlene R. Miller

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: 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. Procedure: 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. Results: 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, P0.001). 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1882-1889
Number of pages8
JournalPediatric Blood and Cancer
Volume60
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Epidemiology
Pediatrics
Infection
Inpatients
Bacteremia
Bone Marrow Transplantation
Intensive Care Units
Catheters
Morbidity

Keywords

  • Central line-associated blood stream infection
  • Central venous catheter/access device
  • Epidemiology
  • Oncology
  • Outpatient management
  • Pediatric
  • Quality improvement

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Rinke, M. L., Milstone, A. M., Chen, A. R., Mirski, K., Bundy, D. G., Colantuoni, E., ... Miller, M. R. (2013). Ambulatory pediatric oncology CLABSIs: Epidemiology and risk factors. Pediatric Blood and Cancer, 60(11), 1882-1889. https://doi.org/10.1002/pbc.24677

Ambulatory pediatric oncology CLABSIs : Epidemiology and risk factors. / Rinke, Michael L.; Milstone, Aaron M.; Chen, Allen R.; Mirski, Kara; Bundy, David G.; Colantuoni, Elizabeth; Pehar, Miriana; Herpst, Cynthia; Miller, Marlene R.

In: Pediatric Blood and Cancer, Vol. 60, No. 11, 11.2013, p. 1882-1889.

Research output: Contribution to journalArticle

Rinke, ML, Milstone, AM, Chen, AR, Mirski, K, Bundy, DG, Colantuoni, E, Pehar, M, Herpst, C & Miller, MR 2013, 'Ambulatory pediatric oncology CLABSIs: Epidemiology and risk factors', Pediatric Blood and Cancer, vol. 60, no. 11, pp. 1882-1889. https://doi.org/10.1002/pbc.24677
Rinke ML, Milstone AM, Chen AR, Mirski K, Bundy DG, Colantuoni E et al. Ambulatory pediatric oncology CLABSIs: Epidemiology and risk factors. Pediatric Blood and Cancer. 2013 Nov;60(11):1882-1889. https://doi.org/10.1002/pbc.24677
Rinke, Michael L. ; Milstone, Aaron M. ; Chen, Allen R. ; Mirski, Kara ; Bundy, David G. ; Colantuoni, Elizabeth ; Pehar, Miriana ; Herpst, Cynthia ; Miller, Marlene R. / Ambulatory pediatric oncology CLABSIs : Epidemiology and risk factors. In: Pediatric Blood and Cancer. 2013 ; Vol. 60, No. 11. pp. 1882-1889.
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abstract = "Background: 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. Procedure: 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. Results: 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, P0.001). 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). Conclusions: 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.",
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AU - Rinke, Michael L.

AU - Milstone, Aaron M.

AU - Chen, Allen R.

AU - Mirski, Kara

AU - Bundy, David G.

AU - Colantuoni, Elizabeth

AU - Pehar, Miriana

AU - Herpst, Cynthia

AU - Miller, Marlene R.

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N2 - Background: 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. Procedure: 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. Results: 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, P0.001). 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). Conclusions: 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.

AB - Background: 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. Procedure: 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. Results: 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, P0.001). 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). Conclusions: 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.

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