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The impact of central line bundles on the timing of catheter-associated bloodstream infections and their microbiological distribution in critically ill children

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Abstract

Catheter-associated bloodstream infection, also known as CLABSI, is the most serious consequence of central venous access devices. These infections increase the risk of mortality and morbidity. The use of central line bundles in clinical settings is increasing worldwide with the purpose of lowering the risk of catheter-associated bloodstream infections. In this study, we investigated the effect of implementing a central line bundle for the prevention of CLABSIs, the distribution of pathogens, and the duration of time it took for CLABSIs to develop in patients who had subclavian-inserted central venous catheters. This research project was a cross-sectional study investigation carried out in a pediatric tertiary teaching hospital. Participants consisted of children who had been admitted to the pediatric critical care unit with subclavian catheters during a period of 13 years. We compared the prebundle period with the bundle period for CLABSI specifically focusing on the time to infection, the number of polymicrobial infections, the proportion of Candida parapsilosis, and the percentage of Coagulase-negative staphylococci (CoNS). The “prebundle period” included the period from May 2007 to May 2013, and the “bundle period” included the period from June 2013 to June 2020. Throughout the course of the study, a total of 286 cases of CLABSI were documented. Among these patients, 141 (49.3%) had CLABSIs associated with subclavian catheters. During the prebundle period, 55 CLABSIs were diagnosed in 5235 central line days, with an overall rate of 10.5 CLABSIs per 1000 central line days; after the implementation of central line bundle, 86 CLABSIs were diagnosed in 12,450 CL days, with an overall rate of 3.6 CLABSIs per 1000 CL days. This showed a statistically significantly lower rate in the bundle period (p = 0.0126). In the prebundle period, the mean time to develop CLABSI was 15 days, whereas during the bundle period, the mean time to develop CLABSI was 27.9 days, a significantly longer time to onset (p = 0.001). While the percentage of other microorganisms was not statistically different between the prebundle and bundle periods (p > 0.05), the percentage of C. parapsilosis was significantly higher in the prebundle period (p = 0.001).

   Conclusion: The results of this study imply that the use of central line bundles not only reduces the incidence of CLABSI but also delays the time to which CLABSI patients acquire an infection. In addition, as a direct consequence of the CLB, the number of CLABSIs caused by gram-positive cocci did not increase, while the proportion of CLABSIs caused by C. parapsilosis decreased.

What is Known:

• The most significant negative consequence of central venous access devices is catheter-associated bloodstream infections.

• “Care bundles” for CLABSI prevention have been reported to reduce the CLABSI rate.

What is New:

• Consider what would happen if the “Care bundle” failed to prevent CLABSI.

• The findings of this study imply that using central line bundles not only reduces the risk of CLABSI but also extends the time it takes for patients to develop CLABSI. While the number of CLABSIs caused by gram-positive cocci did not increase as a direct result of CLB, the rate of CLABSIs caused by C. parapsilosis, which has recently become a major problem, has decreased.

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Data availability

The data of the study is available by the authors upon a reasonable request.

Abbreviations

CLABSIs:

Catheter-associated bloodstream infections

CoNS :

coagulase-negative staphylococci

CVCs:

Central venous catheters

PICCs:

Peripherally inserted central catheters

PICU:

Pediatric intensive care unit

POCUS:

Point of care ultrasonography

IV:

Intravenous

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Author information

Authors and Affiliations

  1. Department of Pediatric Infectious Diseases, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir Faculty of Medicine, University of Health Sciences, İsmet Kaptan Mah, Sezer Doğan Sok, No:11, Konak, Izmir, Turkey

    İlker Devrim, Miray Yılmaz Çelebi, Aybüke Akaslan Kara & Nuri Bayram

  2. Department of Pediatric Intensive Care, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey

    Ozlem Sarac Sandal, Pınar Hepduman, Gülhan Atakul & Hasan Ağın

  3. Department of Pediatrics, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey

    Ahmet Gönüllü

  4. Infection Control Committee, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey

    Yeliz Oruç

  5. Department of Microbiology and Clinical Microbiology, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey

    Gamze Gülfidan

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  1. İlker Devrim
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  11. Hasan Ağın
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Contributions

İlker Devrim, Nuri Bayram performed the research. İlker Devrim, Nuri Bayram, and Hurşit Apa designed research study. Özlem Saraç Sandal, Miray Yılmaz Çelebi, Pınar Hepduman, Ahmet Gönüllü, Gülhan Atakul, Aybüke Akaslan Kara, Yeliz Oruç, and Gamze Gülfidan contributed essential reagents or tools. İlker Devrim analyzed the data. İlker Devrim wrote the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to İlker Devrim.

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Institutional approval was obtained from the Dr. Behçet Uz Children’s Training and Research Hospital Institutional Review Board in accordance with named standard guidelines and regulations.

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Informed consent was obtained from the participants (or, in the case of children under 16 years of age, their parents, or legal guardians) to participate in the study.

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The authors declare no competing interests.

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Communicated by Tobias Tenenbaum

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Devrim, İ., Sandal, O.S., Çelebi, M.Y. et al. The impact of central line bundles on the timing of catheter-associated bloodstream infections and their microbiological distribution in critically ill children. Eur J Pediatr 182, 4625–4632 (2023). https://doi.org/10.1007/s00431-023-05141-7

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