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

摘要

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 utilization 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 noncuffed, 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.