Last update:
   29-Mar-2022
 

Arch Hellen Med, 39(2), March-April 2022, 245-252

ORIGINAL PAPER

Central line-associated bloodstream infections in pediatric patients:
Results from a national nosocomial infections surveillance program

C. Triantafyllou,1 E. Kourkouni,1 D. Gkentzi,2 T. Gouvias,3 G. Dimitriou,2 D. Doganis,4 A. Kaisari,5 A. Kapetanaki,6 G. Karavana,7 K. Karachristou,8
 A. Kontou,9 G. Kourlaba,1 Ι. Kopsidas,1 Μ. Lithoxopoulou,10 N.M. Molocha,1 E. Bouza,11 F. Nikolaou,12 E. Papakonstantinou,13 M. Polychronaki,14
S. Polychronopoulou,15 K. Raptis,16 E. Roilides,17 Μ. Sdougka,18 Ε. Stratiki,19 G. Syrogiannopoulos,20 K. Tataropoulou,21 A. Tragiannidis,22
P. Triantafyllidou,23 H. Tsipou,24 C. Tsirogianni,25 G.C. Tsopela,1 E. Hatzipantelis,22 E. Chorafa,26 E. Chorianopoulou,1 T. Zaoutis1,27
1Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens,
2Department of Pediatrics, Medical School of Patra, Patra,
3Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina,
4Department of Oncology, "P.&A. Kyriakou" Children's Hospital, Athens,
5Unit of Stem Cell Transplant, "Aghia Sophia" Children's Hospital, Athens,
6"Elena Venizelou" General Hospital, Athens,
7Neonatal Intensive Care Unit, "Aghios Panteleimon" General Hospital of Nikaia, Pireus,
8First Neonatal Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens,
9Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki,
10Second Department of Neonatology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki,
11Second Neonatal Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens,
12Pediatric Intensive Care Unit, "P.&A. Kyriakou" Children's Hospital, Athens,
13Department of Pediatric Oncology, "Hippokration" Hospital, Thessaloniki,
14Neonatal Intensive Care Unit, "Venizelio" General Hospital, Heraklion, Crete,
15Department of Pediatric Hematology-Oncology, "Aghia Sophia" Children's Hospital, Athens,
16Neonatal Department and Neonatal Intensive Care Unit, University General Hospital of Alexandroupolis, Alexandroupolis,
17Third Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki,
18Pediatric Intensive Care Unit, "Hippokration" Hospital, Thessaloniki,
19Neonatal Intensive Care Unit, "Alexandra" General District Hospital, Athens,
20Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa,
21Neonatal Intensive Care Unit, "P.&A. Kyriakou" Children's Hospital, Athens,
22Oncology Children's and Adolescents' Pediatric Hematology Unit, Second Pediatric Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki,
23Third Department of Pediatrics, "Attikon" General University Hospital, National and Kapodistrian University of Athens, Athens,
24Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens,
25Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens,
26Unit of Infectious Diseases, Third Department of Pediatrics, School of Medicine, Aristotle University, Thessaloniki, Greece,
27Division of Infectious Diseases, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA

ΟBJECTIVE To provide updated data on the rates of central line-associated bloodstream infections (CLABSI) in Greek neonatal intensive care units (NICUs), pediatric intensive care units (PICUs) and pediatric oncology units (PONCs), and to describe pathogen distribution and antimicrobial resistance patterns for CLABSIs.

METHOD Active surveillance for CLABSI was conducted from June 2016 to December 2019 (43 months). A consortium of 14 NICUs, 3 PICUs, and 6 PONCs participated in the program. Surveillance definitions of central line (CL), central line utilization (CLU) ratio, CLABSI event, and CLABSI rate were based on the 2014 National Healthcare Safety Network criteria of the US Centers for Disease Control and Prevention (CDC). Medical records were assessed daily for calculation of CL-days, patient-days, and susceptibility to isolated organisms.

RESULTS A total of 519 CLABSI episodes were recorded in the 43 months. Mean CLABSI rates were 7.15 in NICUs, 5.19 in PICUs, and 2.20, per 1,000 CL-days in PONCs. A higher mean CLU ratio was reported in PONCs (0.83) and a lower mean ratio was found in NICUs (0.15). A total of 567 pathogens were isolated, the most common of which were Enterobacterales (42.1%), followed by Gram-positive cocci (29%), non-fermenting Gram-negative bacteria (14.6%), and fungi (11.5%). Among 239 (63.1%) Enterobacterales isolated, 151 were multidrug resistant. Overall, 14.8% of Gram-negative pathogens were resistant to third generation cephalosporins and 23.7% to carbapenems.

CONCLUSIONS The rates of CLABSI and antibiotic resistance among organisms causing CLABSI are high in high-risk hospitalized children. These data highlight the significance of this problem and emphasize the need for implementation of infection prevention interventions. The methodology used for this surveillance program could be applied in other pediatric or adult units across Greece.

Key words: Central line, Infection, Infection control, Pediatric patient, Surveillance.

© Archives of Hellenic Medicine