Abstract：
BACKGROUND: The aim of this study was to investigate the applicability of the central line-associated bloodstream infection (CLABSI) criteria of the Centers for Disease Control and Prevention in pediatric oncology patients.
METHODS: Bacteremia episodes from 2020 to 2022 from a prospective cohort of pediatric oncology patients with a central venous catheter were included. Episodes were classified by three medical experts following the CLABSI criteria as either a CLABSI or non-CLABSI (i.e., contamination, other infection source, or mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI)). Subsequently, they were asked if and why they (dis)agreed with this diagnosis following the criteria. The primary outcome was the percentage of episodes where the experts clinically disagreed with the diagnosis given following the CLABSI criteria.
RESULTS: Overall, 84 bacteremia episodes in 71 patients were evaluated. Following the CLABSI criteria, 34 (40%) episodes were classified as CLABSIs and 50 (60%) as non-CLABSIs. In 11 (13%) cases the experts clinically disagreed with the diagnosis following the CLABSI criteria. The discrepancy between the CLABSI criteria and clinical diagnosis was significant; McNemar\'s test p < .01. Disagreement by the experts with the CLABSI criteria mostly occurred when the experts found an MBI-LCBI a more plausible cause of the bacteremia than a CLABSI due to the presence of a gram negative bacteremia (Pseudomonas aeruginosa n = 3) and/or mucositis.
CONCLUSIONS: A discrepancy between the CLABSI criteria and the evaluation of the experts was observed. Adding Pseudomonas aeruginosa as an MBI pathogen and incorporating the presence of mucositis in the MBI-LCBI criteria, might increase the applicability.
METHODS: Bacteremia episodes from 2020 to 2022 from a prospective cohort of pediatric oncology patients with a central venous catheter were included. Episodes were classified by three medical experts following the CLABSI criteria as either a CLABSI or non-CLABSI (i.e., contamination, other infection source, or mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI)). Subsequently, they were asked if and why they (dis)agreed with this diagnosis following the criteria. The primary outcome was the percentage of episodes where the experts clinically disagreed with the diagnosis given following the CLABSI criteria.
RESULTS: Overall, 84 bacteremia episodes in 71 patients were evaluated. Following the CLABSI criteria, 34 (40%) episodes were classified as CLABSIs and 50 (60%) as non-CLABSIs. In 11 (13%) cases the experts clinically disagreed with the diagnosis following the CLABSI criteria. The discrepancy between the CLABSI criteria and clinical diagnosis was significant; McNemar\'s test p < .01. Disagreement by the experts with the CLABSI criteria mostly occurred when the experts found an MBI-LCBI a more plausible cause of the bacteremia than a CLABSI due to the presence of a gram negative bacteremia (Pseudomonas aeruginosa n = 3) and/or mucositis.
CONCLUSIONS: A discrepancy between the CLABSI criteria and the evaluation of the experts was observed. Adding Pseudomonas aeruginosa as an MBI pathogen and incorporating the presence of mucositis in the MBI-LCBI criteria, might increase the applicability.
摘要：
背景：这项研究的目的是调查疾病控制和预防中心的中心管路相关血流感染（CLABSI）标准在儿科肿瘤患者中的适用性。
方法：纳入了使用中心静脉导管的儿科肿瘤患者的前瞻性队列，纳入了2020年至2022年的菌血症发作。根据CLABSI标准，由三名医学专家将发作分类为CLABSI或非CLABSI（即，污染,其他感染源,或粘膜屏障损伤-实验室确认的血流感染（MBI-LCBI））。随后，他们被问及是否以及为什么他们（dis）同意这个诊断遵循标准。主要结果是专家在临床上不同意按照CLABSI标准给出的诊断的发作百分比。
结果：总体而言，评估了71例患者的84次菌血症发作。按照CLABSI标准，34次（40%）被归类为CLABSI，50次（60%）被归类为非CLABSI。在11例（13％）病例中，专家在临床上不同意符合CLABSI标准的诊断。CLABSI标准和临床诊断之间的差异是显著的;McNemar检验p<.01。专家对CLABSI标准的分歧主要发生在专家发现MBI-LCBI比CLABSI更合理的菌血症原因，原因是革兰氏阴性菌血症（铜绿假单胞菌n=3）和/或粘膜炎。
结论：观察到CLABSI标准与专家评估之间存在差异。添加铜绿假单胞菌作为MBI病原体，并将粘膜炎的存在纳入MBI-LCBI标准，可能会增加适用性。
方法：纳入了使用中心静脉导管的儿科肿瘤患者的前瞻性队列，纳入了2020年至2022年的菌血症发作。根据CLABSI标准，由三名医学专家将发作分类为CLABSI或非CLABSI（即，污染,其他感染源,或粘膜屏障损伤-实验室确认的血流感染（MBI-LCBI））。随后，他们被问及是否以及为什么他们（dis）同意这个诊断遵循标准。主要结果是专家在临床上不同意按照CLABSI标准给出的诊断的发作百分比。
结果：总体而言，评估了71例患者的84次菌血症发作。按照CLABSI标准，34次（40%）被归类为CLABSI，50次（60%）被归类为非CLABSI。在11例（13％）病例中，专家在临床上不同意符合CLABSI标准的诊断。CLABSI标准和临床诊断之间的差异是显著的;McNemar检验p<.01。专家对CLABSI标准的分歧主要发生在专家发现MBI-LCBI比CLABSI更合理的菌血症原因，原因是革兰氏阴性菌血症（铜绿假单胞菌n=3）和/或粘膜炎。
结论：观察到CLABSI标准与专家评估之间存在差异。添加铜绿假单胞菌作为MBI病原体，并将粘膜炎的存在纳入MBI-LCBI标准，可能会增加适用性。
