Examining trends in catheter-related infections in critically ill kids

Hospitalization can be a potentially dangerous time for newborns and children who critically ill. The catheter can lead to central catheter–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI). A report in JAMA Pediatrics looks at the current trends for both in children who critically ill.¹

Researchers used pediatric health care–associated infection surveillance data to the National Healthcare Safety Network from 176 hospitals in the United States. Children aged 18 years or younger who were admitted to either pediatric intensive care units or level III neonatal intensive care units were included in the research. The primary outcomes examined were device-linked rates of CLABSI in both neonatal intensive care units and pediatric intensive care units as well as CAUTI in pediatric intensive care units (infections per 1000 device-days). Secondary outcomes were device utilization (device-days per patient-days) and population-based rates (infections per 10,000 patient-days).

Among the 176 hospitals included in the network, 132 hospitals with neonatal intensive care units and 114 hospitals with pediatric intensive care units provided data. Those neonatal intensive care units reported 6,064,172 patient-days iand 1,363,700 central line-days and the pediatric intensive care units had 1,999,979 patient-days, 925,956 central catheter–days, and 327,599 indwelling urinary catheter–days. The neonatal intensive care units showed no significant changes in the annual trends in device-associated (incidence rate ratio [IRR] per year, 0.99; 95% CI, 0.95-1.03) and population-based (IRR, 0.96; 95% CI, 0.92-1.00) CLABSI rates or central catheter utilization (odds ratio [OR], 0.97; 95% CI, 0.95-1.00). Similar results were seen in the pediatric intensive care units, with stability with device-associated (IRR, 1.03; 95% CI, 0.99-1.07) and population-based (IRR, 1.03; 95% CI, 0.99-1.07) CLABSI rates and central catheter utilization (OR, 0.99; 95% CI, 0.97-1.01). Device-linked CAUTI rates in pediatric intensive care units was unchanged over time (IRR, 0.97; 95% CI, 0.91-1.03), but indwelling urinary catheter utilization went down by 6% per year (OR, 0.94; 95% CI, 0.91-0.96) and population-based CAUTI rates decreased by 8% (IRR, 0.92; 95% CI, 0.86-0.98).

The investigators concluded that their findings show that previous improvements made to reduce CLABSI remain, but improvements haven’t been noted. The improvements found in the rate of population-based CAUTI probably reflect a more judicious utilization of urinary catheters.

Reference

1. Hsu H, Mathew R, Wang R, et al. Health care–associated infections among critically ill children in the US, 2013-2018. JAMA Pediatr. October 5, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.3223