Clinical and economic impact of central venous catheter-associated or catheter-related bloodstream infections in pediatric intensive care units: protocol for a systematic review and meta-analysis.

OBJECTIVES: Central venous catheter-associated and catheter-related bloodstream infections may increase mortality, length of stay, and hospital costs in critically ill children. This systematic review will estimate their clinical and economic impact in pediatric intensive care and examine how infection definitions, confounding, and the time-dependent nature of infection influence the evidence.

PATIENTS AND METHODS: Comparative longitudinal observational studies including patients aged 18 years or younger admitted to pediatric intensive care units and exposed to central venous catheters will be eligible. The exposure will be catheter-associated or catheter-related bloodstream infection, compared with patients from the same catheter-exposed source population who are infection-free at the relevant risk time. Mortality, length of stay, and hospital costs are co-primary outcomes. Multiple bibliographic databases, gray-literature sources, and study registries will be searched without date restrictions. Two reviewers will independently select studies, extract data, assess risk of bias, and evaluate certainty. Meta-analysis will be performed when studies are sufficiently comparable; otherwise, structured synthesis will be used.

RESULTS AND CONCLUSIONS: The review is expected to clarify the magnitude and methodological robustness of the clinical and economic consequences of these infections and identify priorities for future pediatric intensive care research.