(839) Quantifying Mortality due to Central Line-Associated Bloodstream Infections in Children

Introduction: While the morbidity associated with central line-associated bloodstream infections (CLABSIs) is evident, higher mortality has not consistently been demonstrated. As CLABSIs are more prevalent in sicker subjects, observational studies may overestimate the association between CLABSIs and mortality due to unmeasured confounding. It is therefore important to assess the plausibility of CLABSIs as a cause of mortality, particularly when designing policies around CLABSI prevention. Therefore, we aimed to quantify the mortality due to CLABSIs, hypothesizing that fewer than 20% of deaths among subjects with a CLABSI would be plausibly linked to a specific CLABSI.

Methods: We performed a retrospective cohort study of non-survivors with hospital acquired CLABSIs between 2014 and 2022 at the Children's Hospital of Philadelphia. Four adjudicators reviewed complete medical records of CLABSI non-survivors from the neonatal, pediatric, and cardiac ICUs, and from the oncology ward. Adjudicators ranked the probability of the death being due to a CLABSI on a 4-point scale: 1 (death definitely not due to CLABSI), 2 (probably not), 3 (potentially), and 4 (death definitely due to CLABSI). Krippendorff’s alpha was used to assess concordance between four reviewers of this ordinal scale.

Results: There were 194 CLABSIs in 149 non-survivors (45 subjects with > 1 CLABSI). The degree of concordance between the four adjudicators was good (alpha = 0.65), suggesting substantial agreement. All four adjudicators scored 28 deaths (14.4%) as plausibly (score 3 or 4) being caused by the CLABSI; 83 deaths (42.8%) were scored by any of the four reviewers as being caused by CLABSI. When restricted to the 149 subjects and their last recorded CLABSI, 18.8% of deaths were scored by all four adjudicators, and 50.3% of deaths were scored by any adjudicator, as being caused by the CLABSI.

Conclusions: In a single center study of pediatric CLABSI non-survivors, the CLABSI itself was adjudicated as contributing to death in 14 to 43% of all cases, and up to 50% of cases when restricted to the final CLABSI for subjects with multiple CLABSIs. Such a significant proportion of deaths plausibly being attributable to CLABSIs reinforces the need to prioritize eradication of CLABSIs.