Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-25T19:35:29.616Z Has data issue: false hasContentIssue false
  • English
  • Français

Is an Increased Dwell Time of a Peripherally Inserted Catheter Associated With an Increased Risk of Bloodstream Infection in Infants?

Published online by Cambridge University Press:  02 January 2015

P. Brian Smith ,
Daniel K. Benjamin Jr. ,
C. Michael Cotten ,
Eric Schultz ,
Rose Guo ,
Lisa Nowell ,
Mary Laura Smithwick  and
Courtney D. Thornburg
P. Brian Smith*
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina Duke Clinical Research Institute, Durham, North Carolina
Daniel K. Benjamin Jr.
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina Duke Clinical Research Institute, Durham, North Carolina
C. Michael Cotten
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina
Eric Schultz
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina
Rose Guo
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina
Lisa Nowell
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina
Mary Laura Smithwick
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina
Courtney D. Thornburg
Affiliation:
Department of Pediatrics, Duke University, Durham, North Carolina
*
Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To estimate the risk of bloodstream infection associated with catheter dwell time in infants.

Design.

Retrospective study.

Setting.

Duke University Medical Center neonatal intensive care unit, an academic, level 3 nursery in Durham, North Carolina.

Methods.

A case of catheter-associated bloodstream infection was defined as one that occurred in an infant whose culture-positive blood sample was collected more than 24 hours after catheter insertion or within 72 hours after catheter removal. We used multivariable logistic regression to control for the catheter's position and dwell time as well as the infant's sex, gestational age, age at time of catheter insertion, birth weight, and weight at time of catheter insertion.

Results.

We identified 135 cases of catheter-associated bloodstream infection. The mean catheter dwell time was 12.2 days (range, 0–113 days), and the mean time to bloodstream infection was 10.8 days (range, 1–57 days). An increase in catheter dwell time was associated with a lower risk of bloodstream infection (odds ratio, 0.975 [95% confidence interval, 0.954–0.996]; P = .02).

Conclusion. No

increased risk of catheter-associated bloodstream infection was observed with increased catheter dwell time. This may have been due to the infant's improved nutrition, decreased need for other invasive devices, and maturing skin and immune system as catheter dwell time increased.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 749 - 753
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
2.Chien, LY, Macnab, Y, Aziz, K, Andrews, W, McMillan, DD, Lee, SK. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002;21:505–511.Google Scholar
3.Aly, H, Herson, V, Duncan, A, et al.Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics 2005;115:1513–1518.CrossRefGoogle ScholarPubMed
4.Stoll, BJ, Hansen, N, Fanaroff, AA, et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.CrossRefGoogle ScholarPubMed
5.Chathas, MK, Paton, JB, Fisher, DE. Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit. Am J Dis Child 1990;144:1246–1250.Google Scholar
6.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002;51(RR-10):1–29.Google Scholar
7.Brooker, RW, Keenan, WJ. Catheter related bloodstream infection following PICC removal in preterm infants. J Perinatol 2007;27:171–174.CrossRefGoogle ScholarPubMed
8.Maas, A, Flament, P, Pardou, A, Deplano, A, Dramaix, M, Struelens, MJ. Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme. J Hosp Infect 1998;40:211–224.Google Scholar
9.Shulman, RJ, Pokorny, WJ, Martin, CG, Petitt, R, Baldaia, L, Roney, D. Comparison of percutaneous and surgical placement of central venous catheters in neonates. J Pediatr Surg 1986;21:348–350.CrossRefGoogle ScholarPubMed
10.Clark, R, Powers, R, White, R, Bloom, B, Sanchez, P, Benjamin, DK Jr. Prevention and treatment of nosocomial sepsis in the NICU. J Perinatol 2004;24:446–453.Google Scholar
11.Cobb, DK, High, KP, Sawyer, RG, et al.A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:1062–1068.Google Scholar
12.Karlowicz, MG, Hashimoto, LN, Kelly, RE Jr., Buescher, ES. Should central venous catheters be removed as soon as candidemia is detected in neonates? Pediatrics 2000;106:E63.Google Scholar
13.Benjamin, DK Jr., Miller, W, Garges, H, et al.Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 2001;107:1272–1276.CrossRefGoogle ScholarPubMed
14.Eppes, SC, Troutman, JL, Gutman, LT. Outcome of treatment of candidemia in children whose central catheters were removed or retained. Pediatr Infect Dis J 1989;8:99–104.Google Scholar
15.Benjamin, DK Jr., Stoll, BJ, Fanaroff, AA, et al.Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics 2006;117:84–92.Google Scholar