Longitudinal Trends in Central Line–Associated Bloodstream Infections in a Pediatric Cardiac Intensive Care Unit: A Three-Year Surveillance Study
Demet Kangel1, Burcu Çevlik1, Ahmet Saki Oğuz1, Elnur Karimov1, Selin Sağlam2, Şenay Çoban1, Ali Can Hatemi3, Erkut Özturk11Department of Pediatric Cardiology, University of Health Sciences, Başakşehir Çam and Sakura Hospital, İstanbul, Türkiye2Department of Anesthesiology and Resuscitation, University of Health Sciences, Başakşehir Çam and Sakura Hospital, İstanbul, Türkiye
3Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Başakşehir Çam and Sakura Hospital, İstanbul, Türkiye
Objectives: Central line–associated bloodstream infections (CLABSIs) remain an important source of morbidity and mortality in pediatric cardiac intensive care units (PCICUs). Although evidence-based prevention bundles can reduce infection rates, sustaining low CLABSI rates in high-acuity settings remains difficult. To evaluate longitudinal trends in CLABSI rates in a pediatric cardiac intensive care unit over a three-year period.
Methods: A retrospective analysis of prospectively collected infection surveillance data was conducted for the period between January 1, 2023, and January 1, 2026. CLABSI rates were calculated as infections per 1,000 central line-days and analyzed quarterly. Observed infection rates were compared with institutional targets and external benchmark data from the Pediatric Cardiac Critical Care Consortium (PC⁴).
Results: A total of 1,800 patients and 24,100 central line-days were evaluated during the study period. Overall, 72 CLABSI episodes were identified, corresponding to a rate of 3.0 infections per 1,000 central line-days. CLABSI rates ranged from 0.5 to 6 infections per 1,000 catheter-days, with the lowest rates observed during 2024 and transient increases during early 2025. Periods with higher infection rates coincided with increased catheter utilization, prolonged catheter dwell time, greater ECMO exposure, and a higher proportion of complex surgical proce-dures. Gram-negative microorganisms predominated (66%), particularly Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. CLABSI-related mortality was 6.9%.
Conclusion: CLABSI rates in this pediatric cardiac intensive care unit showed substantial temporal variability over the three-year surveillance period. Although periods of near-benchmark performance were achieved, sustaining consistently low infection rates remained challenging, particularly during periods of increased patient acuity and device utilization.
Keywords: Central line–associated bloodstream infection, central venous catheter, infection prevention, pediatric cardiac intensive care, quality improvement
Manuscript Language: English
(1 downloaded)