Catheter duration and risk of CLA-BSI in neonates with PICCs

Arnab Sengupta, Christoph Lehmann, Marie Diener-West, Trish M. Perl, Aaron M. Milstone

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

OBJECTIVE: To determine whether the risk of central line-associated bloodstream infections (CLA-BSIs) remained constant over the duration of peripherally inserted central venous catheters (PICCs) in highrisk neonates. PATIENT AND METHODS: We performed a retrospective cohort study of NICU patients who had a PICC inserted between January 1, 2006, and December 31, 2008. A Poisson regression model with linear spline terms to model time since PICC insertion was used to evaluate potential changes in the risk of CLA-BSI while adjusting for other variables. RESOLTS: Six hundred eighty-three neonates were eligible for analysis. There were 21 CLA-BSIs within a follow-up period of 10 470 catheterdays. The incidence of PICC-associated CLA-BSI was 2.01 per 1 000 catheter-days (95% confidence interval [Cl]: 1.24-3.06). The incidence rate of CLA-BSIs increased by 14% per day during the first 18 days after PICC insertion (incidence rate ratio [IRR]: 1.14 [95% Cl: 1.04-1.25]). From days 19 through 35 after PICC insertion, the trend reversed (IRR: 0.8 [95% Cl: 0.66-0.96]). From days 36 through 60 after PICC insertion, the incidence rate of CLA-BSI again increased by 33% per day (IRR: 1.33 [95% Cl: 1.12-1.57]). There was no statistically significant association between the risk of CLA-BSI and gestational age groups, birth weight groups, or chronological age groups. CONCLUSIONS: Our data suggest that catheter duration is an important risk factor for PICC-associated CLA-BSI in the NICU. A significant daily increase in the risk of CLA-BSI after 35 days may warrant PICC replacement if intravascular access is necessary beyond that period.

Original languageEnglish (US)
Pages (from-to)648-653
Number of pages6
JournalPediatrics
Volume125
Issue number4
DOIs
StatePublished - Apr 1 2010

Fingerprint

Central Venous Catheters
Catheters
Newborn Infant
Infection
Incidence
Age Groups
Birth Weight
Gestational Age
Linear Models
Cohort Studies
Retrospective Studies
Confidence Intervals

Keywords

  • Catheter-related infection
  • Infection
  • NICU
  • Peripheral catheterization
  • Peripherally inserted central venous catheters

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Sengupta, A., Lehmann, C., Diener-West, M., Perl, T. M., & Milstone, A. M. (2010). Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics, 125(4), 648-653. https://doi.org/10.1542/peds.2009-2559

Catheter duration and risk of CLA-BSI in neonates with PICCs. / Sengupta, Arnab; Lehmann, Christoph; Diener-West, Marie; Perl, Trish M.; Milstone, Aaron M.

In: Pediatrics, Vol. 125, No. 4, 01.04.2010, p. 648-653.

Research output: Contribution to journalArticle

Sengupta, A, Lehmann, C, Diener-West, M, Perl, TM & Milstone, AM 2010, 'Catheter duration and risk of CLA-BSI in neonates with PICCs', Pediatrics, vol. 125, no. 4, pp. 648-653. https://doi.org/10.1542/peds.2009-2559
Sengupta A, Lehmann C, Diener-West M, Perl TM, Milstone AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics. 2010 Apr 1;125(4):648-653. https://doi.org/10.1542/peds.2009-2559
Sengupta, Arnab ; Lehmann, Christoph ; Diener-West, Marie ; Perl, Trish M. ; Milstone, Aaron M. / Catheter duration and risk of CLA-BSI in neonates with PICCs. In: Pediatrics. 2010 ; Vol. 125, No. 4. pp. 648-653.
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abstract = "OBJECTIVE: To determine whether the risk of central line-associated bloodstream infections (CLA-BSIs) remained constant over the duration of peripherally inserted central venous catheters (PICCs) in highrisk neonates. PATIENT AND METHODS: We performed a retrospective cohort study of NICU patients who had a PICC inserted between January 1, 2006, and December 31, 2008. A Poisson regression model with linear spline terms to model time since PICC insertion was used to evaluate potential changes in the risk of CLA-BSI while adjusting for other variables. RESOLTS: Six hundred eighty-three neonates were eligible for analysis. There were 21 CLA-BSIs within a follow-up period of 10 470 catheterdays. The incidence of PICC-associated CLA-BSI was 2.01 per 1 000 catheter-days (95{\%} confidence interval [Cl]: 1.24-3.06). The incidence rate of CLA-BSIs increased by 14{\%} per day during the first 18 days after PICC insertion (incidence rate ratio [IRR]: 1.14 [95{\%} Cl: 1.04-1.25]). From days 19 through 35 after PICC insertion, the trend reversed (IRR: 0.8 [95{\%} Cl: 0.66-0.96]). From days 36 through 60 after PICC insertion, the incidence rate of CLA-BSI again increased by 33{\%} per day (IRR: 1.33 [95{\%} Cl: 1.12-1.57]). There was no statistically significant association between the risk of CLA-BSI and gestational age groups, birth weight groups, or chronological age groups. CONCLUSIONS: Our data suggest that catheter duration is an important risk factor for PICC-associated CLA-BSI in the NICU. A significant daily increase in the risk of CLA-BSI after 35 days may warrant PICC replacement if intravascular access is necessary beyond that period.",
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AU - Diener-West, Marie

AU - Perl, Trish M.

AU - Milstone, Aaron M.

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N2 - OBJECTIVE: To determine whether the risk of central line-associated bloodstream infections (CLA-BSIs) remained constant over the duration of peripherally inserted central venous catheters (PICCs) in highrisk neonates. PATIENT AND METHODS: We performed a retrospective cohort study of NICU patients who had a PICC inserted between January 1, 2006, and December 31, 2008. A Poisson regression model with linear spline terms to model time since PICC insertion was used to evaluate potential changes in the risk of CLA-BSI while adjusting for other variables. RESOLTS: Six hundred eighty-three neonates were eligible for analysis. There were 21 CLA-BSIs within a follow-up period of 10 470 catheterdays. The incidence of PICC-associated CLA-BSI was 2.01 per 1 000 catheter-days (95% confidence interval [Cl]: 1.24-3.06). The incidence rate of CLA-BSIs increased by 14% per day during the first 18 days after PICC insertion (incidence rate ratio [IRR]: 1.14 [95% Cl: 1.04-1.25]). From days 19 through 35 after PICC insertion, the trend reversed (IRR: 0.8 [95% Cl: 0.66-0.96]). From days 36 through 60 after PICC insertion, the incidence rate of CLA-BSI again increased by 33% per day (IRR: 1.33 [95% Cl: 1.12-1.57]). There was no statistically significant association between the risk of CLA-BSI and gestational age groups, birth weight groups, or chronological age groups. CONCLUSIONS: Our data suggest that catheter duration is an important risk factor for PICC-associated CLA-BSI in the NICU. A significant daily increase in the risk of CLA-BSI after 35 days may warrant PICC replacement if intravascular access is necessary beyond that period.

AB - OBJECTIVE: To determine whether the risk of central line-associated bloodstream infections (CLA-BSIs) remained constant over the duration of peripherally inserted central venous catheters (PICCs) in highrisk neonates. PATIENT AND METHODS: We performed a retrospective cohort study of NICU patients who had a PICC inserted between January 1, 2006, and December 31, 2008. A Poisson regression model with linear spline terms to model time since PICC insertion was used to evaluate potential changes in the risk of CLA-BSI while adjusting for other variables. RESOLTS: Six hundred eighty-three neonates were eligible for analysis. There were 21 CLA-BSIs within a follow-up period of 10 470 catheterdays. The incidence of PICC-associated CLA-BSI was 2.01 per 1 000 catheter-days (95% confidence interval [Cl]: 1.24-3.06). The incidence rate of CLA-BSIs increased by 14% per day during the first 18 days after PICC insertion (incidence rate ratio [IRR]: 1.14 [95% Cl: 1.04-1.25]). From days 19 through 35 after PICC insertion, the trend reversed (IRR: 0.8 [95% Cl: 0.66-0.96]). From days 36 through 60 after PICC insertion, the incidence rate of CLA-BSI again increased by 33% per day (IRR: 1.33 [95% Cl: 1.12-1.57]). There was no statistically significant association between the risk of CLA-BSI and gestational age groups, birth weight groups, or chronological age groups. CONCLUSIONS: Our data suggest that catheter duration is an important risk factor for PICC-associated CLA-BSI in the NICU. A significant daily increase in the risk of CLA-BSI after 35 days may warrant PICC replacement if intravascular access is necessary beyond that period.

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KW - Peripheral catheterization

KW - Peripherally inserted central venous catheters

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