Format

Send to

Choose Destination
J Hosp Infect. 2017 Nov;97(3):267-274. doi: 10.1016/j.jhin.2017.06.023. Epub 2017 Jun 23.

Dwell time and risk of central-line-associated bloodstream infection in neonates.

Author information

1
University of New South Wales, Sydney, Australia.
2
Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia; Department of Neonatology, KK Women's & Children's Hospital, Singapore.
3
Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
4
Department of Newborn Care, Liverpool Hospital, Sydney, New South Wales, Australia.
5
New South Wales Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.
6
Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.
7
University of New South Wales, Sydney, Australia; Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia. Electronic address: k.lui@unsw.edu.au.
8
NICUS, Australia.
9
Canberra Hospital, Australia.
10
John Hunter Children's Hospital, Australia.
11
Royal Prince Alfred Hospital, Australia.
12
Liverpool Hospital, Australia.
13
Nepean Hospital, Australia.
14
The Children's Hospital at Westmead, Australia.
15
Royal North Shore Hospital, Australia.
16
Sydney Children's Hospital, Australia.
17
Westmead Hospital, Australia.
18
Royal Hospital for Women, Australia.

Abstract

BACKGROUND:

Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI).

AIM:

To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially.

METHODS:

The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3).

FINDINGS:

There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12-20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement.

CONCLUSION:

There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.

KEYWORDS:

Central venous catheter; Duration; Hazard; Neonatal intensive care unit; Neonatal sepsis; Nosocomial infection

PMID:
28651859
DOI:
10.1016/j.jhin.2017.06.023
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center