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Intra-abdominal pathology associated with increased CLABSI risk in newborns
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Infants with an active intra-abdominal pathology had a nearly sixfold increased risk for central line-associated bloodstream infections, according to researchers in Canada.
“Most [neonatal] ICUs aim to eliminate [central line-associated bloodstream infections (CLABSIs)], using bundles of measures for [central venous catheter (CVC)] insertion and maintenance,” Maya Dahan, MDCM, of the department of pediatrics at Montreal Children’s Hospital and McGill University, and colleagues wrote. “However, if CLABSIs in specific populations are secondary to gastrointestinal bacterial translocation, these infections are less likely to be prevented via preventive measures that aim to decrease infection due to microorganisms present on the skin. A better understanding of the contribution of intra-abdominal pathologies to the overall risk of CLABSI is needed in the NICU population to better improve our approach to prevention.”
The researchers performed a retrospective, matched case-control study of infants with CLABSI in Montreal Children’s Hospital and Royal Alexandra Hospital, Edmonton, NICUs (n = 120) who were matched with up to three control infants (n = 293) with the potential to develop CLABSIs. Gestational age was less than 28 weeks among 43% of patients; 20% weighed less than 750 g at birth, and 63% were male.
Dahan and colleagues reported several significant risk factors for CLABSI. In matched univariate analysis, an active intra-abdominal pathology was a risk factor (OR = 3.39; 95% CI, 1.81-6.36), as was abdominal surgery within the past 7 days (OR = 3.49; 95% CI, 1.12-10.9), male sex (OR = 1.7; 95% CI, 1.05-2.63) and at least three heel punctures 48 hours before CLABSI (OR = 4.01; 95% CI, 1.93-8.33), according to the researchers.
Intra-abdominal pathology (OR = 5.9; 95% CI, 2.5-14.05) and at least three heel punctures (OR = 5.36; 95% CI, 2.37-12.15) persisted as independent risk factors for CLABSI on a multivariate matched analysis, Dahan and colleagues reported.
“Given our findings, we recommend refining the CLABSI definition to include a subcategory of cases potentially associated with gastrointestinal bacterial translocation,” the researchers wrote. “Future studies should validate the impact of the change in definition.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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