Incidence of catheter-related bloodstream infections after removal of peripherally inserted central catheters in preterm neonates
DOI:
https://doi.org/10.18203/2349-3291.ijcp20200018Keywords:
Catheter related bloodstream infection, Neonatal sepsis, Peripheral inserted central venous catheters preterm, ProphylaxisAbstract
Background: Peripherally inserted central catheter (PICC) have become essential for a safe and reliable long term venous access in all neonatal intensive care units (NICU) for providing long term intravenous fluids and medications. However, they associated with central line blood stream infections (CRBSI) infections and it is postulated that this risk is more on during their removal but the true incidence is not known. The objective was to evaluate the incidence and identify risk factors associated with CRBSI following the PICC removal in preterm neonates.
Methods: This was a retrospective cohort study was done on <37 weeks premature neonates. Data included patient particulars, location of PICC placement, days of PICC, antibiotics and TPN through PICC, infections noted during or within 48 hours of PICC removal.
Results: A total of 238 PICC removals in 215 neonates were analysed which did not show a significant difference in the prevalence of CRBSI within 48 hours of PICC removal. However, there was an increase in odds for sepsis following PICC removal in less than 29 weeks gestation and if it was not used for antibiotic infusion for more than 48 hours preceding its removal.
Conclusions: This study does not support the use of prophylactic antibiotics during PICC removal in neonates as there was no increase in the incidence of CRBSI following PICC removal. However, they may have a role in very low gestation age, low birth weight infants who have not recently received antibiotics prior to PICC removal.
Metrics
References
Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatr. 2013;132(6):1609-15.
Ainsworth SB, McGuire W. Peripherally inserted central catheters vs peripheral cannulas for delivering parenteral nutrition in neonates. Jama. 2016;315(23):2612-3.
Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292(19):2357-65.
O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports. 2002;51(RR-10):1-29.
De Silva GD, Kantzanou M, Justice A, Massey RC, Wilkinson AR, Day NP, et al. The ica operon and biofilm production in coagulase-negative staphylococci associated with carriage and disease in a neonatal intensive care unit. J Clin Microbiol. 2002;40(2):382-8.
Hemels MA, van den Hoogen A, Verboon-Maciolek MA, Fleer A, Krediet TG. Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants. Pediatr Crit Care Med. 2011;12(4):445-8.
Casner M, Hoesli SJ, Slaughter JC, Hill M, Weitkamp JH. Incidence of catheter-related bloodstream infections in neonates following removal of peripherally inserted central venous catheters. Pediatr Crit Care Med. 2014;15(1):42-8.
Reynolds GE, Tierney SB, Klein JM. Antibiotics before removal of percutaneously inserted central venous catheters reduces clinical sepsis in premature infants. The J Pediatr Pharmacol Therapeut. 2015;20(3):203-9.
Sacks GD, Diggs BS, Hadjizacharia P, Green D, Salim A, Malinoski DJ. Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement Central Line Bundle. The Am J Surg. 2014;207(6):817-23.
Brooker RW, Keenan WJ. Catheter related bloodstream infection following PICC removal in preterm infants. J perinatol. 2007;27(3):171.
CATHeTeR R. Catheter-associated bloodstream infections in the NICU: getting to zero. Neonat Net. 2009;28(3):151.
Bannatyne M, Smith J, Panda M, Abdel-Latif ME, Chaudhari T. Retrospective cohort analysis of central line associated blood stream infection following introduction of a central line bundle in a neonatal intensive care unit. Intern J Pediatr. 2018;2018.
Van Den Hoogen A, Brouwer MJ, Gerards LJ, Fleer A, Krediet TG. Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis. Acta Paediatr. 2008;97(9):1250-2.
Sengupta A, Lehmann C, Diener-West M, Perl TM, Milstone AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatr. 2010;125(4):648-53.
Parameswaran R, Sherchan JB, Mukhopadhyay C, Vidyasagar S. Intravascular catheter-related infections in an Indian tertiary care hospital. The J Infect Develop Countr. 2011;5(06):452-8.