From the Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Infect Control Hosp Epidemiol. 2010 Oct;31(10):1049-56. doi: 10.1086/656246.
We sought to identify risk factors for central line-associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions.
Case-control study of children admitted to the medical-surgical intensive care unit (ICU) or cardiac ICU from January 1, 2004, through December 31, 2007.
Children's Hospital Boston is a freestanding, 396-bed quaternary care pediatric hospital with a 29-bed medical-surgical ICU and a 24-bed cardiac ICU.
Case patients were patients with CLABSI who were identified by means of prospective surveillance. Control subjects were patients with a central venous catheter who were matched by ICU admission date.
Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI and to derive and to validate a prediction rule.
Two hundred three case patients were matched with 406 control subjects. Independent predictors of CLABSI included duration of ICU central access (odds ratio [OR] for 15 or more days, 18.41 [95% confidence interval {CI}, 4.10-82.56]; P < .001), central venous catheter placement in the ICU (OR for 2 or more ICU-placed catheters, 8.63 [95% CI, 2.63-28.38]; P = .001), nonoperative cardiovascular disease (OR, 7.44 [95% CI, 2.13-25.98]; P = .012), presence of gastrostomy tube (OR, 3.48 [95% CI, 1.55-7.79]; P = .003), receipt of parenteral nutrition (OR, 3.12 [95% CI, 1.55-6.32]; P = .002), and receipt of blood transfusion (OR, 2.55 [95% CI, 1.21-5.36]; P = .014). By use of risk factors known before central venous catheter placement, our model predicted CLABSI with a positive predictive value of 54% and a negative predictive value of 79%.
Duration of central access, receipt of parenteral nutrition, and receipt of blood transfusion were confirmed as risk factors for CLABSI among children in the ICU. Newly identified risk factors include presence of gastrostomy tube, nonoperative cardiovascular disease, and ICU placement of central venous catheter. Children with these risk factors may be candidates for adjunctive interventions for CLABSI prevention.
本研究旨在确定中心静脉导管相关性血流感染（CLABSI）的危险因素，以明确可能从辅助干预中获益的患儿人群。
2004 年 1 月 1 日至 2007 年 12 月 31 日，对入住波士顿儿童医院外科重症监护病房（SICU）或心脏重症监护病房（CICU）的患儿进行病例对照研究。
波士顿儿童医院是一家独立的 396 床位的四级儿科医院，拥有 29 张床位的 SICU 和 24 张床位的 CICU。
通过前瞻性监测识别 CLABSI 患儿为病例，通过匹配 ICU 入院日期识别中心静脉导管置管患儿为对照。
采用多变量条件逻辑回归模型识别 CLABSI 的独立危险因素，并建立和验证预测规则。
203 例病例患儿与 406 例对照患儿相匹配。CLABSI 的独立预测因素包括 ICU 中央通路时间（15 天或更长时间的比值比[OR]，18.41[95%置信区间{CI}，4.10-82.56]；P<0.001）、ICU 中放置 2 根或更多中心静脉导管（OR，2 根或更多 ICU 置管导管，8.63[95%CI，2.63-28.38]；P=0.001）、非手术性心血管疾病（OR，7.44[95%CI，2.13-25.98]；P=0.012）、存在胃造口管（OR，3.48[95%CI，1.55-7.79]；P=0.003）、接受肠外营养（OR，3.12[95%CI，1.55-6.32]；P=0.002）和输血（OR，2.55[95%CI，1.21-5.36]；P=0.014）。通过使用中央静脉导管置管前已知的危险因素，我们的模型预测 CLABSI 的阳性预测值为 54%，阴性预测值为 79%。
在 ICU 患儿中，中央通路时间、肠外营养和输血被证实为 CLABSI 的危险因素。新确定的危险因素包括胃造口管、非手术性心血管疾病和 ICU 中心静脉导管置管。具有这些危险因素的患儿可能是 CLABSI 预防辅助干预的候选者。
