CLABSI in children during home parenteral nutrition
Abstract:
Introduction: The aim of our study was to determine clinical findings significantly associated with central line associated bloodstream infection (CLABSI) in children on home parenteral nutrition (PN) managed by our intestinal rehabilitation service.
Methods: From 2015–2019 the number of CLABSI was obtained. Additional data collected included: aetiology of intestinal failure (IF), age, oral diet, enteral tube feeding, enterocutaneous stoma, whether single or double lumen central venous catheter(CVC), presence/absence of ileocecal valve (ICV) and number of PN infusions/week.
Results: A total of 58414 catheter days were observed in 58 children (26 male, aged 7.2±4.6 years) at home on PN. Aetiology of IF was intestinal motility disorder(26/58), short bowel syndrome(SBS) (21/58) and enteropathy(Ent) (11/58). 31/58 (53.4%) children (15 M, aged 5.8±4.3 years) developed 108 CLABSIs,1.85/1000 catheter days. Median(range) CLABSI episodes perpatient was 1(0-14). Median days on home PN was 1391(range 75-1565), with median weekly infusion frequency 7 days(range 1-7). CLABSI patients had significantly >PN infusions/week P <0.0001, presence of enterocutaneous stoma (71.3% vs 27%; P <0.0001), double-lumen CVC (24.1% vs 4.8%; P <0.0001), tube feeding (38.9% vs 23.8%; P <0.05) and Motility disorder patients had the highest CLABSI rate(HR 2.1; [95% CI 1.84-3.21]; P <0.00001, total episodes of CLABSI (61.3% vs SBS 31.8% and Ent 27.6%; P<0.0001) and CLABSI rate/1000 catheter days (motility disorder 2.7/1000, SBS 1.17/1000, Ent 1/1000; P<0.0001). Log-rank survival analysis showed that frequency of PN infusion/week(HR 1.3; [95% CI 1.10-.1.51]; P <0.0001), enterocutaneous stoma (HR 3.9; [95% CI 1.95-7.76]; P <0.0001), no ICV (HR 2.37; [95% CI 1.17-4.81]; P <0.05), double-lumen CVC (HR 2.51; [95% CI 1.70-3.86]; P <0.01), age <5 years (HR 2.26; [95% CI 2.16-3.39]; P <0.000001) and male sex (HR 2.51; [95% CI 1.64-3.86]; P <0.00001) were significantly associated with CLABSI. Oral/enteral feeding significantly reduced CLABSI risk (HR 0.54; [95% CI 0.47-0.98.]; P <0.001). COX multivariate analysis showed enterocutaneous stoma, age <5 years and double-lumen CVC were independently associated with CLABSI. Conclusion: In children with an intestinal motility disorder, enterocutaneous stoma, double-lumen CVC and aged <5 years extra care is needed to avoid CLABSI. Reference: D’Eusebio C, Puoti G, King E, Koeglmeier J, Hill S O-01: Clinical Features Significantly Associated with Central Line-associated Blood Stream Infection (Clabsi) in Children on Home Parenteral Nutrition (PN). Transplantation. 2021 Jul 1;105(7S):S1. doi: 10.1097/01.tp.0000757472.51484.93. PMID: 34792932.