Central line-associated blood stream infections and affecting factors in pediatric intensive care unit

Aim: In our study, it was aimed to investigate the rate of CLABSI in PICU, and to determine the most common microorganisms and their resistance rates. In addition, determining the risk factors of CLABSI is another aim of the study. Methods: All patients with CVC who were hospitalized in the PICU of our hospital between September 2017 and December 2021 were included in the study. Patients with missing data, who were discharged within 48 hours after CVC placement, or who died were excluded from the study. Demographic characteristics, clinical information, placed CVC features, blood culture results from CVC, microorganisms and resistance rates of the patients were recorded retrospectively. Results: A total of 157 patients were included in the study. 176 CVCs were placed in 157 patients. Of a total of 176 catheters, 27.7% of the catheters were found to be CLABSI, 12.5% colonization, and 5% contamination. The CLABSI rate in PICU was 15.8 per 1000 CVC days. Of all the isolates, 8.5% were Gram positive, 54.2% were Gram-negative and 37.3% were fungal. The most frequent microorganism was Klebsiella spp. and 70% of Klebsiella species were MDR microorganisms. Patients with longer ICU length of stay (p=0.000) and longer duration of CVC stay (p=0.000) were found to be more likely to have CLABSI. Patients receiving blood products (p=0.008), TPN administration (p=0.004), immunosuppressive states (p=0.006), patients with gastrostomy (p=0.025) and patients receiving continuous sedation (p=0.002) were also associated with increased risk of CLABSI. Patients with malignancy (p=0.047) and TPN treatment (p=0.015) were found to be higher risk of fungal CLABSI. Conclusions: In our study, the CLABSI rate was found as 15.8 per 1000 CVC days, and this value is higher than the literature. It was associated with long-term hospitalization and long-term use of CVCs. Presence of gastrostomy and receiving TPN were found to be independent variables related to the development of infection. Gram-negative agents were the most common cause of CLABSI and MDR microorganisms were prominent. Fungal agents and Gram-negative agents were also found at higher frequencies compared to the literature. The independent variable in fungal infections was the use of TPN.