Clinical and economic impact of central venous catheter-associated or catheter-related bloodstream infections in pediatric intensive care units: protocol for a systematic review and meta-analysis

This OSF project hosts the pre-search protocol and supporting methodological materials for a systematic review and meta-analysis evaluating the clinical and economic impact of central venous catheter-associated or catheter-related bloodstream infections in pediatric intensive care units. The review will include comparative longitudinal observational evidence involving children and adolescents aged 18 years or younger admitted to pediatric intensive care units and exposed to a central venous catheter. Eligible infection constructs include central line-associated bloodstream infection (CLABSI/LCBI), catheter-related bloodstream infection (CRBSI), ANVISA laboratory-confirmed primary bloodstream infection associated with a central venous catheter, ECDC CRI3-CVC, and other explicitly defined operationally equivalent constructs. These definitions will not be assumed to be interchangeable. The three co-primary outcome domains are mortality, length of stay, and hospital costs. Particular attention will be given to confounding and to the time-dependent nature of infection, including the extent to which primary studies appropriately account for infection onset during follow-up. Risk of bias will be assessed using ROBINS-E, and certainty of evidence will be evaluated using GRADE. Meta-analysis will be undertaken only when studies are sufficiently clinically and methodologically comparable; otherwise, findings will be synthesized using a structured approach consistent with SWiM. The review is prospectively registered in PROSPERO under registration number CRD420261475280. This repository will preserve the protocol version history and, as they become available, peer-reviewed search strategies, data extraction materials, methodological decision records, analytical datasets that may legally and ethically be shared, and statistical analysis scripts.