Abstract
Introduction
Central line-associated bloodstream infections (CLABSIs) cause significant morbidity in pediatric hematology/oncology (PHO) patients. While inpatient CLABSIs have been the focus of prevention efforts, ambulatory bloodstream infections (ABSIs) remain less studied. Since December 2011, Children's Hospital of The King's Daughters (CHKD) Division of PHO has maintained a database of ABSI events in PHO patients with CLs to support quality improvement initiatives. This study aimed to categorize ABSI events, identify patient and CL characteristics, and describe clinical outcomes (CO).
Methods
We performed a retrospective chart review of PHO patients with ABSI identified between December 2011 and December 2024. Demographic characteristics, CL type, CL access location, neutropenia, recent transfusions and anesthesia, microbiology, and COs were collected from the electronic medical record. COs included hospitalization, pediatric intensive care unit (PICU) admission, and mortality.
Results
A total of 122 ABSIs were identified among 101 unique patients. Age, sex, and insurance status were comparable to those of the Hampton Roads pediatric population. Of these infections, 108 (89%) were CLABSIs, 12 (10%) were single positive blood infections (SPs), and 2 (2%) were secondary bloodstream infections. Most patients experienced a single infection (84%), while 13% had two infections and 3% had three. CL types included implanted ports (63%), Hickman/Broviac catheters (20%), peripherally inserted central catheters (12%), and other devices (4%). CLs were most commonly last accessed in the outpatient PHO clinic (59%) and the home setting (30%). 18% were last accessed ≥7 days before infection. Neutropenia (ANC 500 cells/µL) was present in 57% of infections. The median hospital length of stay (LOS) was 8 days, 26% of events required PICU admission, 28% required line removal, and overall mortality was 2%. 37% of patients had received a transfusion (mean 3.38 days) and 12% had undergone anesthesia (mean 3.36 days) before infection. COs were similar between CLABSIs and SPs, with a median LOS of 8 days and a PICU admission rate of 25% in both groups. No deaths occurred in SP patients.
Conclusion
ABSIs in PHO patients remain an important source of morbidity, with frequent hospitalization and intensive care needs and merit targeted prevention strategies in the outpatient setting.