Impact of a Best Practice Prevention Bundle on Central Line-associated Bloodstream Infection (CLABSI) Rates and Outcomes in Pediatric Hematology, Oncology, and Hematopoietic Cell Transplantation Patients in Inpatient and Ambulatory Settings

Abstract

Background: Pediatric hematology, oncology, and hematopoietic cell transplantation (HCT) patients are at increased risk for bloodstream infections. The authors sought to evaluate the influence of a standardized best practice central venous catheter (CVC) maintenance bundle on the burden of and risk factors for mucosal barrier injury (MBI) and non-MBI central line-associated bloodstream infections (CLABSIs) across a common inpatient and ambulatory continuum in this high-risk population. Methods: A retrospective cohort study of patients with underlying malignancy, hematologic disorders, and HCT recipients with a CVC in place at the time of CLABSI diagnosis in both inpatient and ambulatory settings from January 1, 2012 to December 31, 2016. Descriptive, nonparametric statistics were used to describe patient characteristics and outcomes. Logistic regression analyses were applied to identify potential risk factors for inpatient versus ambulatory and MBI versus non-MBI CLABSI. Results: During the 5-year period, 118 of 808 (14.6%) patients had 159 laboratory-confirmed CLABSIs for ambulatory and inpatient CLABSI rates of 0.27 CLABSI/1000 and 2.2 CLABSI/1000 CVC days, respectively. CLABSI occurred more frequently in hospitalized patients after HCT and with underlying leukemia, most frequently caused by Gram-negative bacteria. MBI CLABSI accounted for 42% of all CLABSI with a 3-fold higher risk in hospitalized patients. Having multiple CVC or a CVC that was not a port independently associated with higher CLABSI risk. Conclusions: In our cohort, non-MBI CLABSI continued to account for the majority of CLABSI. CVC type is independently associated with higher overall CLABSI risk. Further studies are needed to reliably define additional prevention strategies when CLABSI maintenance bundles elements are optimized in this high-risk population.

Central-line–associated bloodstream infections and central-line–associated non-CLABSI complications among pediatric oncology patients

“…The literature provides confirmatory evidence that catheter choice is an important risk determinant for CVC-associated harm. 5,23,[25][26][27][28][29][30][31] Infants were at high risk for both CLABSIs and CLANCs. Compared to older children, infants were less likely to have mediports and were more likely to have tunneled CVCs.…”

Levofloxacin prophylaxis for pediatric leukemia patients: Longitudinal follow‐up for impact on health care‐associated infections

“…2 Implementation of these strategies reduce the incidence of CLABSI among hospitalized patients, though to a lesser degree in pediatric patients with leukemia. [3][4][5] Many episodes of bacteremia in oncology patients occur with chemotherapy-associated neutropenia, mucositis, and translocation of organisms from oral or gastrointestinal mucosa, thus additional prevention measures have been investigated. [2][3][4][5][6] Studies of adult oncology patients have demonstrated that the use of prophylactic antibiotics during chemotherapy-induced neutropenia is effective in reducing infections, including bacteremia.…”

“…[3][4][5] Many episodes of bacteremia in oncology patients occur with chemotherapy-associated neutropenia, mucositis, and translocation of organisms from oral or gastrointestinal mucosa, thus additional prevention measures have been investigated. [2][3][4][5][6] Studies of adult oncology patients have demonstrated that the use of prophylactic antibiotics during chemotherapy-induced neutropenia is effective in reducing infections, including bacteremia. [7][8][9] Until recently, similar studies in pediatrics were limited to single-center or nonrandomized trials that yielded conflicting results.…”

“…Central line insertion and maintenance bundles are standardized using evidence‐based recommendations to decrease the incidence of central line‐associated bloodstream infection (CLABSI) 2 . Implementation of these strategies reduce the incidence of CLABSI among hospitalized patients, though to a lesser degree in pediatric patients with leukemia 3–5 . Many episodes of bacteremia in oncology patients occur with chemotherapy‐associated neutropenia, mucositis, and translocation of organisms from oral or gastrointestinal mucosa, thus additional prevention measures have been investigated 2–6 …”

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

“…Despite ongoing efforts to reduce central line–associated bloodstream infections (CLABSIs), children with cancer remain at disproportionate risk for these infections relative to other groups of hospitalized pediatric patients (Kelly et al, 2011). Among patients with cancer, those with hematologic malignancies, as well as those with relapsed disease, are at the greatest risk for bloodstream infections (Ardura et al, 2021; Baier et al, 2020; Thurman et al, 2017). Nearly two-thirds of children and adolescents with acute myelogenous leukemia (AML) experience at least one bloodstream infection during their course of therapy (Rogers et al, 2017).…”