Table 1.
Bivariate Risk Factors for Central Line-Associated Bloodstream Infection (CLABSI)
| Cases (N = 54) n (%) |
Controls (N = 108) n (%) |
Odds Ratioa (95% CI) | P | |
|---|---|---|---|---|
| Patient Characteristics | ||||
|
| ||||
| Age in years, median (IQR) | 8.6 (3.6–14.4) | 8.6 (3.9–15.1) | 1.03 (0.97–1.11) | 0.34 |
| Male gender | 34 (63.0) | 63 (58.3) | 1.72 (0.76–3.93) | 0.20 |
| Oncologic Diagnosisb | ||||
| Hematologic malignancy | 45 (86.5) | 56 (53.3) | 2.88 (1.15–7.21) | 0.02 |
| Acute lymphoblastic leukemia (ALL) | 28/45 | 39/56 | ||
| Acute myelogenous leukemia (AML) | 11/45 | 5/56 | ||
| Solid tumor | 7 (13.5) | 49 (46.7) | 1 (reference) | - |
| Uncontrolled oncologic disease | 38 (70.4) | 38 (35.2) | 2.24 (0.96–5.23) | 0.06 |
| Stem cell transplant recipient | 23 (42.6) | 12 (11.1) | 2.99 (1.17–7.68) | 0.02 |
| Acute lymphoblastic leukemia (ALL) | 11/23 | 6/12 | ||
| Acute myelogenous leukemia (AML) | 3/23 | 1/12 | ||
| Days since last chemotherapy, median (IQR) | 4 (0–8) | 1 (1–14) | 0.86 (0.78–0.95) | 0.002 |
| Chemotherapy received within prior 6 weeks | ||||
| Alkylating agent (yes/no) | 22 (40.7) | 57 (52.8) | 0.69 (0.33–1.44) | 0.32 |
| Antibiotic (yes/no) | 17 (31.5) | 51 (47.2) | 0.75 (0.36–1.54) | 0.43 |
| Antimetabolite (yes/no) | 34 (63.0) | 50 (46.3) | 1.87 (0.85–4.16) | 0.12 |
| Agent with moderate-severe myelosuppression (yes/no) | 48 (88.9) | 94 (87.0) | 1.41 (0.66–3.00) | 0.38 |
| Agent with mucosal toxicity (yes/no) | 36 (66.7) | 72 (66.7) | 1.06 (0.47–2.42) | 0.88 |
| Mucositisc | 19 (35.2) | 13 (14.4) | NA | - |
| Minimum ANC (cells/μL) within prior 1 week | ||||
| <100 | 34 (63.0) | 26 (24.1) | 5.00 (1.92–12.99) | 0.001 |
| ≥100 and <500 | 7 (13.0) | 12 (11.1) | 1.81 (0.48–6.84) | 0.38 |
| ≥500 | 13 (24.1) | 70 (64.8) | 1 (reference) | - |
| Blood product transfusion within prior 1 week | ||||
| Red blood cell | 43 (79.6) | 49 (45.4) | 6.77 (2.18–21.04) | 0.001 |
| Platelet | 40 (74.1) | 22 (20.4) | 7.09 (2.64–19.05) | <0.001 |
| Fresh frozen plasma | 6 (11.1) | 2 (1.9) | 4.39 (0.60–32.34) | 0.15 |
| Cryoprecipitate | 1 (1.9) | 1 (0.9) | 0.56 (0.03–9.63) | 0.69 |
| IVIG | 4 (7.4) | 5 (4.6) | 0.34 (0.05–2.51) | 0.29 |
| Poor nutritional status | 7 (14.3) | 13 (12.4) | 0.56 (0.17–1.83) | 0.34 |
| Parenteral nutrition or lipids within prior 1 week | 21 (38.9) | 11 (10.2) | 2.91 (1.07–7.94) | 0.04 |
| Receipt of alteplase within prior 1 week | 6 (11.1) | 11 (10.2) | 1.14 (0.35–3.76) | 0.83 |
| Fluoroscopic contrast study within the prior 1 week | 1 (1.9) | 0 (0.0) | NA | - |
| Procedure within prior 72 hours | 9 (16.7) | 13 (12.0) | 1.67 (0.60–4.66) | 0.32 |
|
| ||||
| Central Venous Catheter Characteristics | ||||
|
| ||||
| Catheter type | ||||
| Tunneled externalized catheter | 28 (51.9) | 15 (13.9) | 3.36 (1.41–7.97) | 0.006 |
| Non-tunneled catheterd | 9 (16.7) | 10 (9.3) | 2.05 (0.69–6.08) | 0.20 |
| Implantable port | 17 (31.5) | 83 (76.9) | 1 (reference) | - |
| Chest insertion site | 45 (83.3) | 95 (88.0) | 0.81 (0.29–2.26) | 0.69 |
| General surgery insertion | 45 (83.3) | 97 (90.0) | 0.37 (0.10–1.32) | 0.13 |
| ≥2 lumens | 33 (61.1) | 20 (18.5) | 2.92 (1.37–6.24) | 0.006 |
| Multiple catheters | 7 (13.0) | 1 (0.9) | 6.59 (0.76–57.33) | 0.09 |
| Duration since placement | ||||
| <1 week | 10 (18.5) | 11 (10.2) | 5.15 (1.82–14.56) | 0.07 |
| ≥1 week and < 1 month | 20 (37.0) | 10 (9.3) | 5.93 (1.52–23.16) | 0.006 |
| ≥1 month | 24 (44.4) | 87 (80.6) | 1 (reference) | - |
| >100 line accesses within prior 72 hours | 16 (29.6) | 3 (2.8) | 8.18 (1.77–37.9) | 0.007 |
CI, confidence interval; IQR, interquartile range; ANC, absolute neutrophil count; NA, not analyzed; IVIG, intravenous immunoglobulin
a
All analyses adjusted for length of hospitalization prior to CLABSI for cases and date of discharge or death for controls.
b
6 patients who had undergone stem cell transplantation for non-malignant condition were not included in this analysis.
c
Mucositis data were missing from the electronic medical records of 0 cases and 18 controls.
d
16 (84%) of the non-tunneled catheters were peripherally inserted central catheters (PICC).