Are enteral devices risk factors for central line-associated bloodstream infections in children with intestinal failure?

Background & aims: Central line-associated bloodstream infections (CLABSI) represent one of the most common and serious complications in children with intestinal failure (IF). This study aimed to assess if there is an association between the use of enteral devices (feeding tubes and stomas) with rate of CLABSI after adjusting for clinically relevant factors. Second, association between enteral devices with time to first CLABSI event was evaluated.

Methods: Retrospective cohort of 202 children with IF and home parenteral nutrition treated at The Hospital for Sick Children between January 2006, and December 2017, with a minimum of 12 months of follow-up. Negative binomial multivariable regression model was used to assess factors associated with rate of CLABSI. Cox proportional hazard regression model was used to assess factors associated with time to first CLABSI event.

Results: The use of feeding tubes [RR 1.10 (95%CI 0.88-1.37); p = 0.407] or stomas [RR 1.00 (95%CI 0.82-1.22); p = 0.974] was not associated with rate of CLABSI after adjusting for confounding factors. There was a significant association between history of prematurity [RR 1.36 (95%CI 1.09-1.70); p = 0.007], male sex [RR 1.28 (95%CI 1.05-1.56); p = 0.016], age at diagnosis of intestinal failure <1 year [RR 2.41 (95%CI 1.75-3.33); p < 0.001], having <50 % of small bowel length expected for age [RR 2.39 (95%CI 1.87-3.05); P < 0.001], and small bowel bacterial overgrowth (SBBO) [RR 1.38 (95%CI 1.10-1.74); p = 0.006], with rate of CLABSI events after multivariable analysis. The use of feeding tubes [HR 0.79 (95%CI 0.49-1.26); p = 0.315] or stomas [HR 1.25 (95%CI 0.81-1.94); p = 0.308] was not associated with time to first CLASBSI episode after multivariable regression analysis. Only length of small bowel <50 % was associated with time to first CLABSI event on multivariable analysis [HR 1.83 (95%CI 1.14-2.93); p = 0.012].

Conclusion: Feeding tubes and stomas were not associated with increased rate of CLABSI or time to first CLABSI episode. However, prematurity, male sex, age at diagnosis of intestinal failure <1 year, having <50 % of small bowel length expected for age, and SBBO were associated with rate of CLABSI events; and having <50 % of small bowel length was associated with time to first CLABSI event. Prospective, multicenter studies accounting for care delivery and prevention bundles are needed to identify patients that would benefit from additional interventions to prevent CLABSI.