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Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.

ABSTRACT: Repair of broken central venous catheters (CVCs) is common in pediatric patients. We hypothesized that this practice predisposes to bacteremia and central line-associated bloodstream infections (CLABSI).We conducted a retrospective case-crossover study of pediatric patients 1 month to 21 years of age with CVC breakages who underwent a first-time repair at our institution, using repair kits provided by CVC manufacturers. We compared rates of bacteremia and CLABSI (defined by Centers for Disease Control and Prevention criteria) in the 30 days prerepair (control period) and the 30 days postrepair (exposure period), with adjustment for within-patient correlation using conditional Poisson regression.The mean prerepair rate of bacteremia was 9.9 per 1000 catheter-days, which increased to 24.5 postrepair, resulting in an adjusted incidence rate ratio (IRR) of 1.87 (95% CI: 1.05-3.33, P = 0.034). Risk of CLABSI demonstrated a greater than 2-fold increase (IRR: 2.15, 95% CI: 1.02-4.53, P = 0.045) when all catheter-days were included, and a 4-fold increase when days on antibiotics were excluded (IRR: 4.07, 95% CI: 1.43-11.57, P = 0.008).We found that repair of a broken CVC was associated with a 2- to 4-fold higher risk of developing CLABSI within 30 days of repair in pediatric patients. Further studies are needed to determine interventions to reduce this risk and to better define the relative merits of CVC repair compared with replacement in selected patient populations.

SUBMITTER: Lundgren IS

PROVIDER: S-EPMC3305844 | biostudies-literature | 2012 Apr

REPOSITORIES: biostudies-literature

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Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.

Lundgren Ingrid S IS Zhou Chuan C Malone Frances R FR McAfee Nancy G NG Gantt Soren S Zerr Danielle M DM

The Pediatric infectious disease journal 20120401 4

<h4>Background</h4>Repair of broken central venous catheters (CVCs) is common in pediatric patients. We hypothesized that this practice predisposes to bacteremia and central line-associated bloodstream infections (CLABSI).<h4>Methods</h4>We conducted a retrospective case-crossover study of pediatric patients 1 month to 21 years of age with CVC breakages who underwent a first-time repair at our institution, using repair kits provided by CVC manufacturers. We compared rates of bacteremia and CLABS ...[more]

PMID: 22146741

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Project description:BackgroundAn increase in the incidence of central venous catheter (CVC)-associated deep venous thrombosis (CADVT) has been reported in pediatric patients over the past decade. At the same time, current screening guidelines for venous thromboembolism risk have low sensitivity for CADVT in hospitalized children. This study utilized a multimodal deep learning model to predict CADVT before it occurs.MethodsChildren who were admitted to intensive care units (ICUs) between December 2015 and December 2018 and with CVC placement at least 3 days were included. The variables analyzed included demographic characteristics, clinical conditions, laboratory test results, vital signs and medications. A multimodal deep learning (MMDL) model that can handle temporal data using long short-term memory (LSTM) and gated recurrent units (GRUs) was proposed for this prediction task. Four benchmark machine learning models, logistic regression (LR), random forest (RF), gradient boosting decision tree (GBDT) and a published cutting edge MMDL, were used to compare and evaluate the models with a fivefold cross-validation approach. Accuracy, recall, area under the ROC curve (AUC), and average precision (AP) were used to evaluate the discrimination of each model at three time points (24 h, 48 h and 72 h) before CADVT occurred. Brier score and Spiegelhalter's z test were used measure the calibration of these prediction models.ResultsA total of 1830 patients were included in this study, and approximately 15% developed CADVT. In the CADVT prediction task, the model proposed in this paper significantly outperforms both traditional machine learning models and existing multimodal deep learning models at all 3 time points. It achieved 77% accuracy and 90% recall at 24 h before CADVT was discovered. It can be used to accurately predict the occurrence of CADVT 72 h in advance with an accuracy of greater than 75%, a recall of more than 87%, and an AUC value of 0.82.ConclusionIn this study, a machine learning method was successfully established to predict CADVT in advance. These findings demonstrate that artificial intelligence (AI) could provide measures for thromboprophylaxis in a pediatric intensive care setting.

Dataset Information

Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.

Publications

Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.

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