Factors Affecting the Timing of a Central Line Associated Bloodstream Infection Onset in Children with Cancer

Abstract

Purpose: The purpose of this study is to identify controllable treatment-environment-related factors affecting the timing of a central line-associated bloodstream infection (CLABSI) onset in children with cancer with central venous catheters (CVC). Design: This study is a secondary data analysis with the data extracted from electronic medical records in a tertiary hospital in South Korea. This study was conducted by reviewing electronic medical records of 470 pediatric cancer patients younger than the age of 18 years from 2010 to 2016. Method: The timing of a CLABSI onset was identified through the onset of CLABSI and the duration of catheterization. Cox proportional hazards regression analysis was used to estimate the impact of variables on the timing of CLABSI onset. The duration of catheterization was estimated using the Kaplan–Meier method. Finding: Multivariable analysis by Cox proportional model analysis showed that there are six independent variables affecting the timing of a CLABSI onset: length of stay in hospital, catheter insertion location, use of antibiotics on day of catheter insertion, catheter function, number of blood transfusions per 100 days, and number of blood tests per 100 days. Conclusions: The findings of this study provide a foundation for the development of EBP-based CVC guidelines to effectively reduce CLABSIs and maintain a long-term CVC without a CLABSI.

Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis

“…Duplicates and articles not published in English were removed, and 2013 articles underwent title and abstract screening. Of these, 167 underwent full-text review and 23 studies were identified that met the inclusion criteria 10–31. All studies were included.…”

“…Prophylactic antibiotics were given in four studies (one with haematological disease only and three with solid and haematological malignancies) 16–18 23. Antibiotics were explicitly stated as not given in two studies (both haematological malignancies only) 10 19.…”

Changes in Central Line–Associated Bloodstream Infection (CLABSI) Rates Following Implementation of Levofloxacin Prophylaxis for Children and Adolescents With High-Risk Leukemia

“…For patients with high-risk leukemia and those undergoing HSCT, this timing corresponds with periods of peak mucosal injury following receipt of chemotherapy and an increased risk of bacteremia (Bowen et al, 2019; Donohoe et al, 2018). Prior studies suggest that the complex transfusion needs patients experience during periods of prolonged myelosuppression are associated with an increased risk of infection (Kelly et al, 2011; Park et al, 2021). Although the need for more frequent blood product transfusions is often associated with increased manipulation of the line, it may also be a marker of compromised hemostasis and an underlying pathophysiologic context in which MBI and non-MBI organisms may more easily translocate into the bloodstream.…”

Adverse events related to central venous catheters (CVC) and the influence of CVC characteristics on peripheral blood hematopoietic progenitor cell collection in children

“…They have only been described in patients, hence, in cases in which CVC manipulation was more frequent, and their duration was also longer. Frequent manipulations, blood draws, infusions, and the time that the CVC is being used are variables frequently related to these complications in other series (8).…”

“…Although the adverse events related to central venous lines are not infrequent in pediatric patients, they have mainly been described in patients with several prothrombotic conditions at the time of the events or at high risk of infection (6)(7)(8). For instance, intensive care or oncology patients.…”