The risk of central line-associated bloodstream infections with different types of central vascular catheters in a multidisciplinary neonatal and pediatric intensive care unit

Objective. Central line-associated bloodstream infections (CLABSIs) are a significant cause of morbidity in critically ill neonates and children. The objective of this study was to compare CLABSI rate associated with different types of central vascular catheters (CVCs) in a multidisciplinary neonatal and pediatric intensive care unit (ICU).

Methods. A prospective cohort study was conducted in a multidisciplinary neonatal and pediatric ICU. All patients, admitted between January 1st 2011 and February 29th 2012, requiring a CVC were included and monitored for CLABSI (defined by CDC/NHSN criteria). CLABSI rates were calculated for each type of CVC as CLABSI episodes/1000 catheter-days. CLABSI rates were compared between patients with single and multiple CVCs.

Results. Of the 557 patients admitted, 362 (65%) required insertion of a CVC (4259 patient-days, 3225 catheter-days, CVC uti-lization ratio 0.76). There were 14 episodes of CLABSI. CLABSI rate was lowest for umbilical catheters (0/1000 catheter-days), followed by short-term noncuffed and nontunneled CVCs (3.1/1000 catheter-days) and peripherally inserted CVCs (8.8/1000 catheter-days). Higher rates were observed with long-term cuffed and tunneled CVCs (15.9/1000 catheter days) and noncu-ffed, nontunneled CVCs for temporary renal replacement therapy (RRT) (20.0/1000 catheter days). CLABSI rate expressed per 1000 catheter-days was 3.0 and 19.7 for patients with single or multiple CVCs at the same time, respectively. Conclusion. The use of noncuffed, nontunneled CVCs for temporary RRT and the presence of multiple CVCs at the same time are associated with a significant increase in the rate and risk of developing CLABSI in a multidisciplinary neonatal and pediatric ICU population.

central line-associated bloodstream infections, nosocomial infections, central vascular cathe-ter, bloodstream infections, pediatric intensive care unit, neonate, child

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2. Aly H, Herson V, Duncan A, Herr J, Bender J, Patel K, et al. Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics 2005;115:1513-8.

3. Yogaraj JS, Elward AM, Fraser VJ. Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2002;110:481-5.

4. Odetola FO, Moler FW, Dechert RE, van der Elzen K, Chenoweth C. Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: Risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 2003;4:432-6.

5. Elward AM, Fraser VJ. Risk factors for nosocomial primary bloodstream infection in pediatric intensive care unit patients: a 2-year pros-pective cohort study. Infect Control Hosp Epidemiol 2006;27:553-60.

6. Costello JM, Graham DA, Morrow DF, Potter-Bynoe G, Sandora TJ, Laussen PC. Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatr Crit Care Med 2009;10:453-9.

7. Niedner MF, Huskins WC, Colantuoni E, Muschelli J, Harris II JM, Rice TB, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol 2011;32(12):1200-8.

8. Nowak JE, Brilli RJ, Lake MR, Sparling KW, Butcher J, Schulte M, Wheeler DS. Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: Business case for quality improvement. Pediatr Crit Care Med 2010;11:579-87.

9. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805.

10. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-71.

11. Wagner M, Bonhoeffer J, Erb TO, Glanzmann R, Hacker FM, Paulussen M, et al. Prospective study on central venous line associated bloodstream infections. Arch Dis Child 2011;96:827-31.

12. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32.

13. Almuneef MA, Memish ZA, Balkhy HH, Hijazi O, Cunningham G, Francis C. Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006;62:207-13.

14. Becerra MR, Tantalean JA, Suarez VJ, Alvarado MC, Candela JL, Urcia FC. Epidemiologic surveillance of nosocomial infections in a pediatric intensive care unit of a developing country. BMC Pediatrics 2010;10:66.

15. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Inten-sive Care Med 2004;30:62-7.

16. Aly H, Herson V, Duncan A, Herr J, Bender J, Patel K, et al. Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics 2005;115:1513-8.

17. Yogaraj JS, Elward AM, Fraser VJ. Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2002;110:481-5.

18. Odetola FO, Moler FW, Dechert RE, van der Elzen K, Chenoweth C. Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: Risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 2003;4:432-6.

19. Elward AM, Fraser VJ. Risk factors for nosocomial primary bloodstream infection in pediatric intensive care unit patients: a 2-year pros-pective cohort study. Infect Control Hosp Epidemiol 2006;27:553-60.

20. Costello JM, Graham DA, Morrow DF, Potter-Bynoe G, Sandora TJ, Laussen PC. Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatr Crit Care Med 2009;10:453-9.

21. Niedner MF, Huskins WC, Colantuoni E, Muschelli J, Harris II JM, Rice TB, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol 2011;32(12):1200-8.

22. Nowak JE, Brilli RJ, Lake MR, Sparling KW, Butcher J, Schulte M, Wheeler DS. Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: Business case for quality improvement. Pediatr Crit Care Med 2010;11:579-87.

23. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805.

24. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-71.

25. Wagner M, Bonhoeffer J, Erb TO, Glanzmann R, Hacker FM, Paulussen M, et al. Prospective study on central venous line associated bloodstream infections. Arch Dis Child 2011;96:827-31.

26. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32.

27. Almuneef MA, Memish ZA, Balkhy HH, Hijazi O, Cunningham G, Francis C. Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006;62:207-13.

28. Becerra MR, Tantalean JA, Suarez VJ, Alvarado MC, Candela JL, Urcia FC. Epidemiologic surveillance of nosocomial infections in a pediatric intensive care unit of a developing country. BMC Pediatrics 2010;10:66.