Central line-associated bloodstream infections in children: a systematic review and meta-analysis.

Abstract

Background: Central line-associated bloodstream infection (CLABSI) in pediatric patients poses significant clinical challenges, with prevention strategies heavily reliant on identifying modifiable risk factors. Despite numerous studies investigating these risk factors, heterogeneity in study designs, populations, and regional settings necessitates a systematic synthesis of evidence to guide clinical practice. This meta-analysis aims to consolidate existing data and quantify key risk factors for pediatric CLABSI.

Methods: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for observational studies (cohort and case-control) published up to April 1, 2024. Two independent reviewers screened studies, extracted data, and assessed quality using the MOOSE checklist for observational meta-analyses. Meta-analyses were performed using Stata 15.0 software, with pooled odds ratios (ORs) and 95% confidence intervals (CIs) calculated via random-effects models. Heterogeneity was evaluated with I² statistics.

Results: Seventeen studies (17 cohort studies) involving 15,221 pediatric patients were included. Significant risk factors for CLABSI were: blood transfusions (OR =5.69; 95% CI: 2.93-11.05), congenital diseases (OR =2.58; 95% CI: 1.14-5.83), central nervous system (CNS) diseases (OR =4.13; 95% CI: 1.17-9.98), total parenteral nutrition (OR =4.37; 95% CI: 1.14-16.82), multiple catheters (OR =4.16; 95% CI: 2.36-7.31), prolonged catheterization time (OR =1.19; 95% CI: 1.08-1.30). Subgroup analyses confirmed consistency across regions and study types (I²<50% for most factors).

Conclusions: This meta-analysis identifies blood transfusions, congenital/CNS comorbidities, parenteral nutrition, and catheter-related practices as critical modifiable risk factors for pediatric CLABSI. Clinicians should prioritize early catheter removal, judicious blood product use, and intensified monitoring for high-risk patients. These findings align with existing guidelines but provide stronger evidence for pediatric-specific protocols.