092 - Characterization and Assessment of Central Line Associated Bloodstream Infections Requiring Hospitalization in Pediatric Oncology Patients

Publication Number: 92.4300

Jacquelyn R. Hovey, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Andrew Tran, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Mistie Cook, Arkansas Children’s Hospital, Austin, AR, United States; Elizabeth Marrero, Arkansas Children's Hospital, Little Rock, AR, United States; Jasmin Cotoco, University of Arkans, North Little Rock, AR, United States; Jason E. Farrar, Arkansas Children's, Little Rock, AR, United States; Joana Mack, Arkansas Children's Hospital, Little Rock, AR, United States

Background: Patients with cancer require prolonged central venous access to optimize their care. This, however, increases risk of central line-associated bloodstream infections (CLABSIs), a significant cause of morbidity and mortality.

Objective: This study aims to analyze distribution of infection events, identify patterns and outcomes associated with different types of infections, and provide insights for developing targeted infection control measures for pediatric oncology patients.

Design/Methods: This was an IRB-exempt, single institution study conducted between 2018 and 2025 and included patients with a CLABSI and oncologic diagnosis. Data on infection timing, organism classification, type of central access, and patient demographics, including the Area Deprivation Index (ADI), were collected and analyzed.

Results: 85 pediatric patients with CLABSI were reviewed. The cohort was 61% female and had a median age of 8 years, with an equal split of inpatient and ambulatory cases. The most frequent diagnoses were B-acute lymphoblastic leukemia (32.9%), acute myeloid leukemia (22.4%), and neuroblastoma (10.6%). Gram-positive bacteria were most prevalent, comprising 52.9% of infections, followed by gram-negative bacteria at 42.4% and fungal organisms at 4.7% . P. aeruginosa was the most common pathogen, seen in 18.8% of cases, followed by methicillin-susceptible S. aureus and S. mitis, at 15.6% each. Gram-negative infections were more frequently managed by maintaining the central line (82.8%) compared to gram-positive (64.4%) (Figure 1). From a relatively low historical baseline, CLASBI rates fell during the COVID-19 pandemic but spiked 5-fold the year after social restrictions were lifted, a period also corresponding to high nursing turnover. These rates have improved since establishing a dedicated CLASBI rounding team in August 2022 and are on track to return to baseline. No significant correlation was found between viral respiratory infections, intraoperative antibiotic use, mucosal barrier injury, or ADI.

Conclusion(s): This study provides insights into the epidemiology of CLABSIs and medical management approaches in our population. The data highlight the importance of targeted infection control measures and the benefit of coordinated care efforts and well-trained specialty nurses, evidenced by reduction in CLABSIs following implementation of a CLABSI rounding team. Future direction includes further research into the social exposome, investigation of chemotherapy timing relative to infection onset, and cumulative chemotherapy exposure to better refine our infection prevention strategies and optimize patient outcomes.

Figure 1
A heat map demonstrating prevalence of organism category and associated outcome. For example, one can determine from this image that, for outcomes for Gram-positive organisms include 0 deaths, 16 CLABSIs resulting in line removal, and 29 CLABSIs which were treated by maintaining central access.