Official Title
Using Microbial Genomics to Elucidate the Source of Central-line Associated Bloodstream Infections
Brief Title
Using Microbial Genomics to Elucidate the Source of Central-line Associated Bloodstream Infections
Protocol ID
NCT02271243
Lead Sponsor
Boston Children's Hospital
Brief Summary
Central line-associated bloodstream infections (CLABSIs) are the most common
healthcare-associated infection in children and are associated with morbidity and
mortality. This study will attempt to identify the source of bloodstream infections
(BSIs) in children with CLABSI because we hypothesize that many of the BSIs that are
currently classified as CLABSIs are actually laboratory-confirmed bloodstream infections
(LCBI) that may be a result of mucosal barrier injury (MBI), also known as MBI-LCBI. In
order to study this, we will isolate bacteria from multiple body sites of children that
have BSI in order to compare these bacteria to the strain growing in their blood using
whole-genome DNA sequencing. We will also evaluate biomarkers of MBI of the respiratory
tract and GI tract.
Detailed Description
This is a prospective cohort pilot study at Boston Children's Hospital (BCH) that will
explore the source of presumed CLABSI, which we believe may actually have multiple
possible sources including MBI. We plan to enroll all inpatient children at BCH who meet
the Centers for Disease Control and Prevention (CDC) definition of MBI-LCBI as well as
children who meet the criteria for CLABSI without MBI. For all enrolled patients, we will
collect samples from the oral cavity, respiratory tract, skin, and stool. These samples
will be cultured in order to see if the same microbial species and strain(s) growing from
the blood also grow from these other sites. Cultures will then have isolated colonies
selected for whole-genome DNA sequencing to allow assessment of genomic diversity between
body sites. Stool and blood samples will be tested for markers of MBI. All patient
enrollment and sample collection will be done at BCH.
Enrollment Count
60 participants
Eligibility Criteria
Inclusion Criteria:
- Hospitalized at Boston Children's Hospital
- Central venous catheter of any type including peripherally inserted central
catheters (PICC) in any location.
- Laboratory-confirmed bloodstream infection (LCBI) diagnosed by a clinical blood
culture growing certain Gram-negative rods
Exclusion Criteria:
- Patients with CDC-defined secondary bloodstream infections
Filters
Laboratory-confirmed Bloodstream Infection
Central Line-associated Bloodstream Infections
Mucosal Barrier Injury
UNKNOWN
CHILD
ADULT
OLDER_ADULT