Susan A Gutierrez, Vikram Raghu, Stephanie B Oliveira, Vivien Nguyen, Amy M Shui, Debra L Sudan, Conrad Cole, Chiung-Yu Huang, Sue Rhee, Jennifer C Lai, Sharad I Wadhwani
{"title":"美国儿童短肠综合征中线相关血流感染率:2016年至2023年的回顾性队列研究","authors":"Susan A Gutierrez, Vikram Raghu, Stephanie B Oliveira, Vivien Nguyen, Amy M Shui, Debra L Sudan, Conrad Cole, Chiung-Yu Huang, Sue Rhee, Jennifer C Lai, Sharad I Wadhwani","doi":"10.1002/jpen.2766","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Central line-associated bloodstream infections (CLABSIs) are the leading cause of hospitalization in pediatric short bowel syndrome, disproportionately impacting socioeconomically disadvantaged children. We examined changes in overall CLABSI rates over time and assessed whether socioeconomic disparities persist.</p><p><strong>Methods: </strong>Using the Pediatric Health Information System database, we studied short bowel syndrome patients aged <18 years hospitalized between 2015 and 2023. Patients were stratified into neighborhood income groups based on zip code-based median household income. CLABSI rates were assessed with mixed-effects Poisson regression over four eras (2016-2017, 2018-2019, 2020-2021, 2022-2023).</p><p><strong>Results: </strong>Of 8772 hospitalizations of 2048 children with short bowel syndrome at 43 institutions, CLABSI was the principal diagnosis for 30% of hospitalizations. Univariable analysis showed decreased CLABSI rates during 2018-2019 (rate ratio [RR] 0.71, 95% CI 0.63-0.81; P < 0.001), 2020-2021 (RR 0.66, 95% CI 0.57-0.75; P < 0.001), and 2022-2023 (RR 0.60, 95% CI 0.52-0.70; P < 0.001), relative to 2016-2017. In multivariable analyses, 2022-2023 was associated with lower CLABSI rates relative to 2016-2017 (RR 0.61, 95% CI 0.52-0.70; P < 0.001). Low neighborhood income (RR 1.59, 95% CI 1.14-2.21; P < 0.001), public insurance (RR 1.59, 95% CI 1.37-1.84; P < 0.001), and non-Hispanic Black race (RR 1.19, 95% CI 1.01-1.39; P = 0.03) were associated with higher CLABSI rates relative to high neighborhood income, private insurance, and non-Hispanic White race, respectively.</p><p><strong>Conclusion: </strong>CLABSI rates in pediatric short bowel syndrome have decreased over the past 8 years, yet socioeconomic and racial disparities persist. Efforts to prevent CLABSI across the socioeconomic spectrum should be prioritized to improve short bowel syndrome outcomes.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Central line-associated bloodstream infection rates in pediatric short bowel syndrome in the United States: A retrospective cohort study from 2016 to 2023.\",\"authors\":\"Susan A Gutierrez, Vikram Raghu, Stephanie B Oliveira, Vivien Nguyen, Amy M Shui, Debra L Sudan, Conrad Cole, Chiung-Yu Huang, Sue Rhee, Jennifer C Lai, Sharad I Wadhwani\",\"doi\":\"10.1002/jpen.2766\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Central line-associated bloodstream infections (CLABSIs) are the leading cause of hospitalization in pediatric short bowel syndrome, disproportionately impacting socioeconomically disadvantaged children. We examined changes in overall CLABSI rates over time and assessed whether socioeconomic disparities persist.</p><p><strong>Methods: </strong>Using the Pediatric Health Information System database, we studied short bowel syndrome patients aged <18 years hospitalized between 2015 and 2023. Patients were stratified into neighborhood income groups based on zip code-based median household income. CLABSI rates were assessed with mixed-effects Poisson regression over four eras (2016-2017, 2018-2019, 2020-2021, 2022-2023).</p><p><strong>Results: </strong>Of 8772 hospitalizations of 2048 children with short bowel syndrome at 43 institutions, CLABSI was the principal diagnosis for 30% of hospitalizations. Univariable analysis showed decreased CLABSI rates during 2018-2019 (rate ratio [RR] 0.71, 95% CI 0.63-0.81; P < 0.001), 2020-2021 (RR 0.66, 95% CI 0.57-0.75; P < 0.001), and 2022-2023 (RR 0.60, 95% CI 0.52-0.70; P < 0.001), relative to 2016-2017. In multivariable analyses, 2022-2023 was associated with lower CLABSI rates relative to 2016-2017 (RR 0.61, 95% CI 0.52-0.70; P < 0.001). Low neighborhood income (RR 1.59, 95% CI 1.14-2.21; P < 0.001), public insurance (RR 1.59, 95% CI 1.37-1.84; P < 0.001), and non-Hispanic Black race (RR 1.19, 95% CI 1.01-1.39; P = 0.03) were associated with higher CLABSI rates relative to high neighborhood income, private insurance, and non-Hispanic White race, respectively.</p><p><strong>Conclusion: </strong>CLABSI rates in pediatric short bowel syndrome have decreased over the past 8 years, yet socioeconomic and racial disparities persist. Efforts to prevent CLABSI across the socioeconomic spectrum should be prioritized to improve short bowel syndrome outcomes.</p>\",\"PeriodicalId\":16668,\"journal\":{\"name\":\"Journal of Parenteral and Enteral Nutrition\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-04-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Parenteral and Enteral Nutrition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jpen.2766\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Parenteral and Enteral Nutrition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jpen.2766","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:中心线相关血流感染(CLABSIs)是儿童短肠综合征住院的主要原因,对社会经济条件较差的儿童影响较大。我们检查了总体CLABSI率随时间的变化,并评估了社会经济差异是否持续存在。方法:利用儿科健康信息系统数据库,对老年短肠综合征患者进行研究。结果:在43所医院的2048例短肠综合征患儿的8772例住院中,CLABSI是30%住院患者的主要诊断。单变量分析显示,2018-2019年CLABSI发生率下降(比率比[RR] 0.71, 95% CI 0.63-0.81;结论:小儿短肠综合征的CLABSI发生率在过去8年中有所下降,但社会经济和种族差异仍然存在。应优先努力预防跨社会经济范围的CLABSI,以改善短肠综合征的结局。
Central line-associated bloodstream infection rates in pediatric short bowel syndrome in the United States: A retrospective cohort study from 2016 to 2023.
Background: Central line-associated bloodstream infections (CLABSIs) are the leading cause of hospitalization in pediatric short bowel syndrome, disproportionately impacting socioeconomically disadvantaged children. We examined changes in overall CLABSI rates over time and assessed whether socioeconomic disparities persist.
Methods: Using the Pediatric Health Information System database, we studied short bowel syndrome patients aged <18 years hospitalized between 2015 and 2023. Patients were stratified into neighborhood income groups based on zip code-based median household income. CLABSI rates were assessed with mixed-effects Poisson regression over four eras (2016-2017, 2018-2019, 2020-2021, 2022-2023).
Results: Of 8772 hospitalizations of 2048 children with short bowel syndrome at 43 institutions, CLABSI was the principal diagnosis for 30% of hospitalizations. Univariable analysis showed decreased CLABSI rates during 2018-2019 (rate ratio [RR] 0.71, 95% CI 0.63-0.81; P < 0.001), 2020-2021 (RR 0.66, 95% CI 0.57-0.75; P < 0.001), and 2022-2023 (RR 0.60, 95% CI 0.52-0.70; P < 0.001), relative to 2016-2017. In multivariable analyses, 2022-2023 was associated with lower CLABSI rates relative to 2016-2017 (RR 0.61, 95% CI 0.52-0.70; P < 0.001). Low neighborhood income (RR 1.59, 95% CI 1.14-2.21; P < 0.001), public insurance (RR 1.59, 95% CI 1.37-1.84; P < 0.001), and non-Hispanic Black race (RR 1.19, 95% CI 1.01-1.39; P = 0.03) were associated with higher CLABSI rates relative to high neighborhood income, private insurance, and non-Hispanic White race, respectively.
Conclusion: CLABSI rates in pediatric short bowel syndrome have decreased over the past 8 years, yet socioeconomic and racial disparities persist. Efforts to prevent CLABSI across the socioeconomic spectrum should be prioritized to improve short bowel syndrome outcomes.
期刊介绍:
The Journal of Parenteral and Enteral Nutrition (JPEN) is the premier scientific journal of nutrition and metabolic support. It publishes original peer-reviewed studies that define the cutting edge of basic and clinical research in the field. It explores the science of optimizing the care of patients receiving enteral or IV therapies. Also included: reviews, techniques, brief reports, case reports, and abstracts.