Effect of Catheter Dwell Time on Risk of Central Line–Associated Bloodstream Infection in Infants
Year: 2015
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND OBJECTIVE: Central venous catheters in the NICU are associated with significant morbidity and mortality because of the risk of central line-associated bloodstream infections (CLABSIs). The purpose of this study was to determine the effect of catheter dwell time on risk of CLABSI. METHODS: Retrospective cohort study of 13,327 infants with 15,567 catheters (93% peripherally inserted central catheters [PICCs], 7% tunneled catheters) and 256,088 catheter days cared for in 141 NICUs. CLABSI was defined using National Health Surveillance Network criteria. We defined dwell time as the number of days from line insertion until either line removal or day of CLABSI. We generated survival curves for each week of dwell time and estimated hazard ratios for CLABSI at each week by using a Cox proportional hazards frailty model. We controlled for postmenstrual age and year, included facility as a random effect, and generated separate models by line type. RESULTS: Median postmenstrual age was 29 weeks (interquartile range 26-33). The overall incidence of CLABSI was 0.93 per 1000 catheter days. Increased dwell time was not associated with increased risk of CLABSI for PICCs. For tunneled catheters, infection incidence was significantly higher in weeks 7 and 9 compared with week 1. CONCLUSIONS: Clinicians should not routinely replace uninfected PICCs for fear of infection but should consider removing tunneled catheters before week 7 if no longer needed. Additional studies are needed to determine what daily maintenance practices may be associated with decreased risk of infection, especially for tunneled catheters.
Source: PEDIATRICS
Authors: Rachel G. Greenberg, Keith M. Cochran, P. Brian Smith, Barbara S. Edson, Joseph Schulman, Henry C. Lee, Balaji Govindaswami, Alfonso Pantoja, Doug Hardy, John Curran, Della Lin, Sheree Kuo, Akihiko Noguchi, Patricia Ittmann, Scott Duncan, Munish Gupta, Alan Picarillo, Padmani Karna, Morris Cohen, Michael Giuliano, Sheri Carroll, Brandi Page, Judith Guzman-Cottrill, M. Whit Walker, Jeff Garland, Janice K. Ancona, Dan L. Ellsbury, Matthew M. Laughon, Martin J. McCaffrey
Institutions: Duke University, Duke Clinical Research Institute, University of North Carolina at Chapel Hill, American Hospital Association, California Department of Health Care Services, Stanford Medicine, Stanford University, Santa Clara Valley Medical Center, Santa Clara Valley Health and Hospital System, Exempla Saint Joseph Hospital, Winnie Palmer Hospital for Women & Babies, University of South Florida, University of Hawaiʻi at Mānoa, University of Hawaii System, Kapiolani Medical Center for Women and Children, Saint Louis University, Javon Bea Hospital-Rockton, University of Louisville, Beth Israel Deaconess Medical Center, University of Massachusetts Chan Medical School, Michigan State University, Hackensack University Medical Center, Oregon Health & Science University, Prisma Health, Wheaton Franciscan Healthcare
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Health Research and Educational Trust, National Institutes of Health, U.S. Food and Drug Administration, National Institute of Child Health and Human Development, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Duke Research Training Program for Pediatricians, G1600858300, Duke CTSA (Composite), G3008453, G3851912115, G4322685311, G4521433050, G5119124739, G5139652136, Multidisciplinary Neonatal Training Grant, Antimicrobial pharmacokinetics and outcomes in vulnerable infants, G6365708837, G6496590010, Increasing the Quality and Efficiency of Clinical Trials (R18), G7018197903, G7177219445, G7634447104, Fungal biomarkers for diagnosis and response to therapy for pediatric candidemia, G8960167436
OpenAlex ID: W2215554332