Elsevier

American Journal of Infection Control

Volume 36, Issue 10, December 2008, Pages S173.e1-S173.e3
American Journal of Infection Control

Brief report
Catheter-related bloodstream infections in children

https://doi.org/10.1016/j.ajic.2008.10.012Get rights and content

Epidemiology

Patient characteristics and system-level factors place children at increased risk for catheter-related bloodstream infection (CR-BSI). National Healthcare Safety Network data from 36 pediatric intensive care units (PICUs) demonstrate a pooled mean of 5.3 CR-BSIs per 1000 catheter-days and a median of 3.5 CR-BSIs per 1000 catheter-days. Almost 60% of CR-BSIs in children are caused by gram-positive bacteria. In the PICU setting, arterial catheterization, increased duration of catheterization, use of extracorporeal life support, and presence of a genetic abnormality are independent risk factors for CR-BSIs.

Economics

In children, cost estimates range from $36,000 to $50,000 per CR-BSI.

Treatment

Empiric therapy should target gram-positive and gram-negative bacteria, with the choice of drug treatment based on local antimicrobial susceptibility patterns. Results from pediatric studies shows that catheter removal is indicated for all cases of candidemia and persistent bacteremia.

Prevention

Based on limited data, antimicrobial lock therapy may be appropriate in certain clinical situations, and multifaceted interventions are effective in reducing CR-BSIs in children. In one center, maximum barrier precautions during insertion, antimicrobial-impregnated catheters, annual hospital-wide handwashing campaigns, physical barriers between beds, and use of 2% chlorhexidine skin disinfectant decreased CR-BSIs.

Section snippets

Epidemiology of BSI in children

Most of the information about pediatric CR-BSIs is derived from children in ICUs. Historical data are derived from nationally representative surveys, such as the National Nosocomial Infections Surveillance System, the Pediatric Prevention Network, and the National Healthcare Safety Network (NHSN). The most recent NHSN data from 36 pediatric ICUs demonstrate a pooled mean of 5.3 BSI per 1000 catheter-days, with a median of 3.5 BSIs per 1000 catheter-days and interquartile (IQ) range of 1.1 to

Risk factors for development of BSI in children

Few studies have examined independent risk factors for health care-associated infections in children, and these have been limited to the pediatric ICU setting. One study reported that parenteral nutrition or antimicrobial therapy was independently associated with health care-associated infection in the ICU.3 Studies focusing specifically on BSIs have found that arterial catheterization, increased duration of catheterization, receipt of extracorporeal life support, and presence of a genetic

Economics of BSI in children

The costs of BSIs in children have been estimated in 3 studies at different centers using different methodologies. These estimates range from approximately $36,000 to $50,000 per CR-BSI.7, 8, 9

Treatment of BSIs in children

Guidelines for the management of BSIs in children are limited and derived largely from adult data. Given the distribution of organisms in Table 1, empiric therapy should target gram-positive and gram-negative bacteria, with the choice of specific agents based on local antimicrobial susceptibility patterns. Evidence from pediatric studies shows that the catheter should be removed in all cases of candidemia10 and persistent bacteremia.11

Prevention of BSI in children

There have been several randomized controlled trials (RCTs) of antibiotic catheter lock solutions. One study found a significant decrease in CR-BSIs in children with tunneled central venous catheters using a vancomycin lock12; however, a second RCT was unable to confirm these findings.13 A third RCT found that both vancomycin-heparin and vancomycin-ciprofloxacin-heparin lock solutions significantly reduced the rate of CR-BSIs compared with heparin-only lock solutions.14 Another RCT showed that

Summary and key points

  • 1.

    CR-BSIs represent the most common health care-associated infections in pediatric patients.

  • 2.

    Data regarding the efficacy and safety of treatment and prevention strategies in children are limited, although the use of antimicrobial catheter lock solutions may be indicated in certain clinical situations.

  • 3.

    Despite limited data for specific interventions, multifaceted interventions are effective in reducing CR-BSIs in children.

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Disclosures: Dr. Smith received an honorarium for participating in the symposium and writing this article. The author reports no conflicts of interest.

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