Central line-associated bloodstream infection in hospitalized children: a retrospective cohort study of risk, mortality, and antimicrobial resistance

Background Central line-associated bloodstream infection (CLABSI) remains an important complication of central venous catheter use in children, particularly where antimicrobial resistance limits treatment options. We evaluated patient-level CLABSI risk, mortality-associated factors, bloodstream-isolate distribution, time to documented culture negativity, and multidrug resistance (MDR) in a mixed-ward pediatric cohort. Methods This retrospective, single-center cohort included hospitalized children younger than 18 years with central venous catheters at a tertiary pediatric referral hospital in Tehran, Iran, from 2021 to 2024. Modified Poisson regression estimated adjusted risk ratios for CLABSI. Among children with CLABSI, factors associated with in-hospital mortality were evaluated using Firth penalized logistic regression, and model performance was internally assessed using bootstrap validation. Organism distribution and antimicrobial-susceptibility analyses were conducted at the isolate level; primary MDR prevalence was estimated at the patient level. Results Among 723 eligible children, 182 (25.2%) had at least one CLABSI and 128 (17.7%) died in hospital. All-cause in-hospital mortality among children with CLABSI was 22.0%. Compared with the PICU/general ICU, CLABSI risk was higher in the cardiac ICU/open-heart ICU (adjusted risk ratio [aRR], 1.35; 95% CI, 1.00–1.82) and lower in transplant/oncology (aRR, 0.57; 95% CI, 0.37–0.88). Femoral catheter placement (adjusted odds ratio [aOR], 3.04; 95% CI, 1.37–6.82) and each halving of platelet count (aOR, 1.51; 95% CI, 1.20–1.94) were associated with mortality. Klebsiella spp. and Staphylococcus epidermidis predominated. MDR was detected in 82.0% of assessable children. Time to documented culture negativity differed across organism groups ( P = 0.002). Conclusions At least one CLABSI occurred in 25.2% of eligible children with CVCs; all-cause in-hospital mortality among children with CLABSI was 22.0%, and MDR was detected in 82.0% of assessable children. Ward-specific surveillance, reliable central-line insertion and maintenance practices, regular review of line necessity, and locally informed antimicrobial stewardship are priorities.