Costello et al identified risk factors for central line-associated (CLA) bloodstream infection (BSI) in pediatric patients in a cardiac intensive care unit (ICU). These can help to identify a patient at risk who may benefit from more aggressive management. The authors are from Children's Hospital Boston and Harvard Medical School.
Patient selection: pediatric patient in cardiac ICU, from 1 day to 18 years
Risk factors for central line associated bloodstream infection:
(1) NOT an elective cardiac surgical admission
(2) presence of one or more non-cardiac comorbidities
(3) initial absolute neutrophil count < 5,000 per µL
(4) transfusion of >= 3 blood products (any kind)
(5) central line present for >= 7 days
(6) therapy with hydrocortisone for presumed adrenal insufficiency
where:
• The odds ratio was highest for hydrocortisone therapy (OR 29) while the others had ORs ranged from 5 to 7).
• The size of the blood products was not specified, with no distinction between a Pedipak and a standard unit.
Risk factors for CLA BSI in those patients undergoing cardiac surgery:
(1) admission weight <= 5 kilograms
(2) PRISM III >= 15 during the first 24 hours (greater initial disease severity)
(3) transfusion of >= 3 blood products (any kind)
(4) mechanical ventilation >= 7 days
(5) RACHS1 category 3 to 6 (moderate to marked complexity)
where:
• The odds ratio are all in the OR 3-4 range..
Recommendations for reducing central line infections:
(1) sterile technique while inserting, handling and removing any line, catheter or device
(2) removal of central line and other devices as soon as possible
(3) minimize the need for (control blood loss, etc) and use of blood products
(4) minimize access to the central line
(5) considering the use of antibiotic-coated catheters in high risk patients
(6) more aggressive risk reduction if moderate to high risk
