Risk factors for catheter-related bloodstream infection in children undergoing blood purification therapy: a retrospective cohort study.

BACKGROUND

Catheter-related bloodstream infection (CRBSI) remains a major complication in children undergoing blood purification therapy, contributing to increased morbidity and healthcare burden. However, evidence regarding its risk factors in this specific population remains limited. This study aimed to investigate the risk factors for catheter-related infection during blood purification therapy in children, thereby providing evidence-based insights for optimizing central venous catheter (CVC) management and nursing strategies.

METHODS

This retrospective study enrolled pediatric patients who received blood purification therapy and had indwelling CVCs. Data on general demographics, underlying diseases, catheter-related factors, treatment modalities, and nursing practices were collected. CRBSI was diagnosed based on the Centers for Disease Control and Prevention (CDC) criteria, which include both microbiologically confirmed and clinically diagnosed cases. Potential associated factors were initially screened via univariate analysis, followed by multivariate logistic regression analysis to identify independent factors for catheter-related infection.

RESULTS

Multivariate logistic regression analysis revealed that an immunosuppressed state [odds ratio (OR) =2.182, 95% confidence interval (CI): 1.101-4.327], femoral vein catheterization (OR =2.445, 95% CI: 1.275-4.689), catheter diameter ≥7 Fr (OR =2.201, 95% CI: 1.006-4.812), and prolonged catheter indwelling (OR =1.344, 95% CI: 1.229-1.469) were independent risk factors for catheter-related infection in children undergoing blood purification therapy (all P<0.05). Standardized and timely dressing changes served as a protective factor (OR =0.355, 95% CI: 0.142-0.889, P=0.03). Chlorhexidine-alcohol use for skin antisepsis, total parenteral nutrition (PN) administration, and catheter reinsertion showed no statistically significant association with CRBSI occurrence after adjusting for confounding factors.

CONCLUSIONS

In pediatric blood purification therapy, immunosuppression, femoral vein catheterization, large-diameter catheters, and prolonged indwelling time increase the risk of catheter-related infection, whereas standardized dressing changes exert a protective effect. Clinical practice should enhance risk assessment and standardize catheter management protocols to reduce infections.