Central line colonization,central line infection, Central line-associated and Catheter-related bloodstream infections in Greek pediatric intensive care patients: a prospective one year study

The purpose of this study (prospective one year study of all patients requiring a central line) is to present central line colonization, central line infection, central line-associated and catheter-related bloodstream infection rates, risk factors, and the outcomes in a multidisciplinary Greek pediatric intensive care unit. 81 patients required 136 episodes of catheterization with duration of 9 (5.25-14.75) days. Device utilization ratio was 0.8. Eleven patients developed 17 episodes of central line-associated blood-stream infection (CLABSI) in 1629 catheter days, given a CLABSI rate of 10.43:1000. 3 catheter tip cultures revealed the same microorganism as the bloodstream infection (BSI), specified a catheter-related (CRBSI) rate of 1.84:1000. Catheter tip infection occurred at a rate of 3.69:1000, whereas catheter colonization at 8.59:1000. Gram-positive microorganisms predominated in CLABSIs (52.94%), whilst Gram-negative pathogens predominated in colonization (64.28%), infection (66.66%), and CRBSI (66.66%), Acinetobacter baumanii being the principal pathogen. CLABSI patients had longer duration (days) of catheterization (17 vs 9, P=0.014), mechanical ventilation (17 vs 8, P=0.014), and unit stay (17 vs 10, P=0.037), without an impact on mortality. CLABSIs occurred more often in patients with Hickman catheters (P=0.003), co morbidities (P=0.000), multiple catheterizations (P=0.003), complications (P=0.008) and corticosteroid use (P=0.044). Hickman catheters [odds ratio (OR) 8.381; 95% confidence intervals (CI): 1.1-66.1, P=0.044]and co morbidities [OR: 5.904; 95% CI: 1.2-28.9, P=0.029)] were independent predictors of CLABSIs. CLABSI rate in our study is higher than the international standards. Preventive measures, such as improvements in central line insertion and maintenance bundles of care, are necessary, to lower this baseline rate in future comparisons.