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

作者：Sanderson E; Yeo K T; Wang A Y; Callander I; Bajuk B; Bolisetty S; Lui K^*

来源：Journal of Hospital Infection, 2017, 97(3): 267-274.

DOI：10.1016/j.jhin.2017.06.023

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

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.

• 出版日期2017-11