Risk Factors of Ambulatory Central Line–Associated Bloodstream Infection in Pediatric Short Bowel Syndrome

Background Children with short bowel syndrome (SBS) receiving home parenteral nutrition (HPN) are predisposed to ambulatory central line–associated bloodstream infection (A‐CLABSI). Data describing risk factors of this infection in children are limited. Methods Retrospective cohort, single‐center, case‐crossover study of children ≤18 years old with SBS receiving HPN from January 2012 to December 2016. Univariate and multivariate mixed effect Poisson regression identified the relative risk (RR) of A‐CLABSI with proposed risk factors. Results Thirty‐five children were identified; median follow‐up was 30 months. A‐CLABSI rate was 4.2 per 1000 central line (CL) days. Univariate analysis identified younger age (RR: 0.92 per 12‐month increase [95% confidence interval {CI}: 0.85‐0.99; P = 0.036]), shorter small intestine length (RR: 0.96 per 10‐cm increase [95% CI: 0.92‐0.99; P = 0.008]), lower citrulline level (RR: 0.86 per 5‐nmol/mL increase [95% CI: 0.75‐0.99; P = 0.036]), and recent CL break (RR: 1.55 [95% CI: 1.06‐2.28; P = 0.024]) as risk factors for A‐CLABSI. Multivariate analysis showed increased A‐CLABSI with clinical diagnosis of small intestine bacterial overgrowth (SIBO) (RR: 1.87 [95% CI: 1.1‐3.17; P = 0.021]) and CL breaks (RR: 1.49 [95% CI: 1‐2.22; P = 0.024]). Conclusions Factors influencing gut integrity increase A‐CLABSI rate, supporting translocation as an important mechanism and target for prevention. Clinical diagnosis of SIBO increases A‐CLABSI rate, but whether dysbiosis or diarrhea is responsible is an area for future research. CL maintenance is crucial, and prevention of breaks would likely decrease A‐CLABSI rate.