Do Intra-abdominal Conditions Represent an Independent Risk Factor for Central Line Associated Bloodstream Infections (CLABSI) in the NICU?
Bibliographic record
Abstract
Background. Central line-associated bloodstream infections (CLABSI) impact infants' outcomes. Our aim was to determine if intra-abdominal pathologies are an independent risk factor for CLABSI. Methods. We performed a case-control study of infants admitted to the NICUs of the Montreal Children's Hospital (Montreal) and the Royal Alexandra Hospital (Edmonton), Canada. CLABSI cases that occurred between April 2009 and March 2014 were identified through the Infection Control database. For each case, up to 3 controls were matched (NHSN birth weight category, chronological age, and central venous catheter (CVC) dwell time at the time of case's CLABSI onset). Data were analyzed using conditional logistic regression (STATA 13.1). Results. We identified 120 cases and 293 controls; 51 cases (43%) were <28 weeks gestation (median GA: 29 weeks); 24 (20%) had a birth weight of <750 grams (median BW: 1105 grams) and 76 (63%) were males. At CLABSI onset, median CVL dwell time was 10 days and median patient age was 18.5 days. Primary diagnosis among cases was prematurity 47 (39%) followed by intra-abdominal pathologies 27 (23%). Overall, 27 % of cases (n = 32) had one or more active intra-abdominal pathologies in the week preceding CLABSI onset, compared with 11% (n = 33) controls. In infants without an arterial line, 30% of cases (n = 31/102) and 9% of controls (n = 23/247) had > 3 heel punctures in the 48 hours before CLABSI onset. On matched univariate analysis, the following variables were significant risk factors for CLABSI: active intra-abdominal pathology (OR = 3.4; 95% CI, 1.8–6.4), abdominal surgery in the prior 7 days (OR = 3.6; 95% CI, 1.0–13.0); male sex (OR = 1.7; 95% CI, 1.1–2.6) and >3 heel punctures (OR = 4.0; 95% CI, 1.9–8.3). On multivariable matched analysis, intra-abdominal pathology (OR = 4.6; 95% CI, 2.1–10.1), >3 heel punctures (OR = 5.0; 95% CI, 2.3–10.9) and male sex (OR = 1.8; 95% CI, 1.01–3.2) remained independent risk factors for CLABSI. Conclusion. The presence of an active intra-abdominal pathology increases the risk of CLABSI by >4-fold. Similarly to CLABSI in oncology patients, a subgroup of CLABSI with mucosal barrier injury may be considered for infants in the NICU with active intra-abdominal pathology. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".