1. Ambulatory central line associated bacterial infection (CLABSI) rates in children were associated with significant morbidity and mortality.
2. Modifiable risk factors for CLABSI included central line type, line placement setting, serum albumin level, and antimicrobial prophylaxis.
Evidence Rating Level: 2 (Good)
Study Rundown: Inpatient CLABSIs have been shown to cause significant morbidity and mortality in hospitalized children. Despite the prevalent use of central lines (CLs) amongst children in the outpatient setting, there is a paucity of data regarding ambulatory CLABSIs. This multicenter study analyzed the incidence density, risk factors, and outcomes in children with ambulatory CLABSIs. Outpatient CLABSIs occurred in nearly 15% of children with ambulatory CLs. The incidence density of ambulatory CLABSIs was 40% lower than inpatient CLABSIs reported in previous studies. Patients with tunneled catheters, recent clinic visits, and low serum albumin levels had higher risk of developing ambulatory CLABSIs. CL placement in the operating room and antibiotic prophylaxis were associated with decreased incidence of CLABSIs. These findings provide potential targets for quality improvement efforts in reducing the incidence of ambulatory CLABSIs and their associated morbidity and mortality in children.
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Relevant Reading: Polymicrobial bloodstream infections among children and adolescents with central venous catheters evaluated in ambulatory care
In-Depth [retrospective cohort]: This study included 1658 patients less than 22 years of age with CLs at five urban tertiary care centers from October 2010 through September 2015. Ambulatory CLABSIs were defined as positive blood cultures drawn < 48 hours after admission to a hospital or > 48 hours after discharge from a hospital. CLABSI incidence density was defined as the number of CLABSIs per 1000 ambulatory CL days. 466 ambulatory CLABSIs out of a total of 481,204 ambulatory CL days were identified, for an incidence density of 0.97 CLABSIs per 1000 CL days (95% CI 0.88-1.06). Comparatively, Inpatient CLABSI rates in 2018 occurred at an incidence density of 1.36 per 1000 CL days. 85 out of the 466 patients required hospitalization, and 16 of these required ICU care. 1% of patients died within 30 days of diagnosis. Patients with tunneled externalized catheters had significantly higher incidence densities (2.58) than patients with peripherally inserted central line catheters or total implantable devices (1.46 and 0.23 respectively). Additionally, access at a clinic visit within 30 days (OR=2.8, P=0.004) and low serum albumin concentration (OR 2.3, P=0.013) were associated with increased ambulatory CLABSIs. CLs placed in an operating room (OR 0.36, P= 0.01) and use of prophylactic antimicrobial agents within the preceding 30 days (OR=0.22, P<0.0001) reduced the odds of CLABSIs.
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