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.