Abstract
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.
Highlights
During the last few decades, the development of new techniques to provide central vascular access has been a revolutionary step in the care of critically ill neonates and children
We identified a total of 4259 patientdays, 3225 catheter-days (CVC utilization ratio 0.76) and 14 episodes of Central line-associated bloodstream infections (CLABSIs) with an overall CLABSI rate of 4.3/1000 catheter-days in our pediatric intensive care units (PICU)
(9) The higher CLABSI rate in our study could be attributable to the large proportion of neonates, including extremely premature neonates, in our PICU that are known to be at highest risk for CLABSI. [9] a high percentage of our patients are neonates and children undergoing complex cardiac surgery that are known to have higher CLABSI rates, partly because of extensive use of invasive devices. [9,16] in a multicenter study that included multidisciplinary as well as dedicated cardiac PICUs, CLABSI rate was the same as in our study
Summary
During the last few decades, the development of new techniques to provide central vascular access has been a revolutionary step in the care of critically ill neonates and children. [10] it is generally acknowledged that the same principle applies for pediatric population, the magnitude of variability in CLABSI rate with different types of CVCs in critically ill neonates and children is largely unknown. A study of CLABSI rates in all children under care in a children's hospital (intensive care, general wards, out-patient setting) identified the highest risk of CLABSI in neonates with peripherally inserted central venous catheters (PICCs) and the lowest risk in children with totally implanted CVCs (Porth-a-cath). Patients being cared for in a multidisciplinary neonatal and pediatric ICU probably have a different CLABSI risk profile. Few data exist regarding CLABSI rates with different types of CVCs in multidisciplinary PICUs. [4] The goal of this study was to prospectively assess the current burden of CLABSI in our multidisciplinary neonatal and pediatric ICU and to identify the CLABSI rate associated with different types of CVCs
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