Methods: We performed a case-control study of infants admitted to the NICUs of the Montreal Children’s Hospital (Montreal) and the Royal Alexandra Hospital (Edmonton), Canada. CLABSI cases that occurred between April 2009 and March 2014 were identified through the Infection Control database. For each case, up to 3 controls were matched (NHSN birth weight category, chronological age, and central venous catheter (CVC) dwell time at the time of case’s CLABSI onset). Data were analyzed using conditional logistic regression (STATA 13.1).
Results: We identified 120 cases and 293 controls; 51 cases (43%) were <28 weeks gestation (median GA: 29 weeks); 24 (20%) had a birth weight of <750g (median BW: 1105g) and 76 (63%) were males. At CLABSI onset, median CVL dwell time was 10 days and median patient age was 18.5 days. Primary diagnosis among cases was prematurity 47 (39%) followed by intra-abdominal pathologies 27 (23%). Overall, 27 % of cases (n=32) had one or more active intra-abdominal pathologies in the week preceding CLABSI onset, compared to 11% (n=33) controls. In infants without an arterial line, 30% of cases (n=31/102) and 9% of controls (n=23/247) had > 3 heel punctures in the 48 hours prior to CLABSI onset.
On matched univariate analysis, the following variables were significant risk factors for CLABSI: active intra-abdominal pathology (OR 3.4; 95%CI 1.8-6.4), abdominal surgery in the prior 7 days (OR 3.6; 95%CI 1.0-13.0); male sex (OR 1.7; 95%CI: 1.1-2.6) and >3 heel punctures (OR 4.0; 95%CI: 1.9-8.3). On multivariable matched analysis, intra-abdominal pathology (OR 4.6; 95%CI 2.1-10.1), > 3 heel punctures (OR 5.0; 95%CI 2.3-10.9) and male sex (OR 1.8; 95%CI 1.01-3.2) remained independent risk factors for CLABSI.
Conclusion: The presence of an active intra-abdominal pathology increases the risk of CLABSI by > 4-fold. Similarly to CLABSI in oncology patients, a subgroup of CLABSI with mucosal barrier injury may be considered for infants in the NICU with active intra-abdominal pathology.
J. Hebert, None
M. Gonzales, None
B. Lee, None
A. U. Chandran, None
S. Woolsey, None
S. Excoredo, None
H. Chinnery, None
C. Quach, None