Abstract
BackgroundThe central-line associated bloodstream infections (CLABSI) are the most common healthcare-associated infections in childhood. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. The present survey is the first prospective study monitoring for 6 months the occurrence of central-line associated bloodstream infections in all departments of an Italian tertiary care children’s university hospital.MethodsThe study involved all children aged less than 18 years admitted to Meyer Children’s University Hospital, Florence, Italy who had a central line access between the October 15th, 2014 and the April 14th, 2015. CLABSI were defined according to the Center for Disease Control and Prevention criteria. CLABSI incidence rates with 95% confidence limits were calculated and stratified for the study variables. For each factor the relative risk and 95% confidence intervals were evaluated. Statistical analysis was performed using the statistical software SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL), p < 0.05 was considered statistically significant.ResultsCLABSI rate was 3.73/1000 (95% CI: 2.54–5.28) central line-days. A higher CLABSI incidence was seen with female gender (p = 0.045) and underlying medical conditions (excepting prematurity, surgical diseases and malignancy) (p = 0.06). In our study 5 infections, were caused by extended-spectrum β-lactamase producing organisms and in one case by carbapenem-resistant Klebsiella pneumoniae.ConclusionsOur study confirms the spreading of multi-resistant pathogens as causes of healthcare associated infections in children. An increased incidence rate of CLABSI in our study was related to underlying medical conditions. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas.
Highlights
The central-line associated bloodstream infections (CLABSI) are the most common healthcareassociated infections in childhood
A prospective study performed in 29 neonatal intensive care unit (NICU) in United States between October 2006 and December 2007 found that the risk of CLABSI is very low during the first week of catheterization and especially with lines inserted in the jugular vein, whereas it is increased in oncological and gastrointestinal patients and in case of prolonged catheterization [6]
If we consider only these types of patients in our study, the CLABSI rate decreases to 2.69/1000 catheters-days
Summary
The central-line associated bloodstream infections (CLABSI) are the most common healthcareassociated infections in childhood. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. Despite the international data available on HAIs in selected groups of patients, there is a lack of large and good quality studies. A prospective study performed in 29 NICU in United States between October 2006 and December 2007 found that the risk of CLABSI is very low during the first week of catheterization and especially with lines inserted in the jugular vein, whereas it is increased in oncological and gastrointestinal patients and in case of prolonged catheterization [6]. There are few prospective studies performed in a whole hospital in order to investigate the global incidence of HAIs. A Swiss study performed in a single institution between April 2008 and March 2009 on 152 patients showed an overall CLABSI incidence of 0.95/ 1000 central line-days. CLABSI incidence varied by type of catheter and by patient’s age, with the highest risk in neonates with Silastic® percutaneous central line [10]
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