Dwell time and risk of central-line-associated bloodstream infection in neonates

Sanderson, E; Yeo, KT; Wang, AY; Callander, I; Bajuk, B; Bolisetty, S; Lui, K; Bowen, J; Sedgley, S; Carlisle, H; Kent, A; Smith, J; Craven, P; Cruden, L; Argomand, A; Rieger, I; Malcolm, G; Lutz, T; Reid, S; Stack, J; Medlin, K; Marcin, K; Shingde, V; Chin, MF; Bonzer, K; Badawi, N; Halliday, R; Karskens, C; Paradisis, M; Kluckow, M; Jacobs, C; Numa, A; Williams, G; Young, J; Luig, M; Baird, J; Oei, JL; Cameron, D

Dwell time and risk of central-line-associated bloodstream infection in neonates

Sanderson, E Yeo, KT Wang, AY

Callander, I Bajuk, B Bolisetty, S Lui, K Bowen, J Sedgley, S Carlisle, H Kent, A Smith, J Craven, P Cruden, L Argomand, A Rieger, I Malcolm, G Lutz, T Reid, S Stack, J Medlin, K Marcin, K Shingde, V Chin, MF Bonzer, K Badawi, N Halliday, R Karskens, C Paradisis, M Kluckow, M Jacobs, C Numa, A Williams, G Young, J Luig, M Baird, J Oei, JL Cameron, D

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Publication Type:: Journal Article
Citation:: Journal of Hospital Infection, 2017, 97 (3), pp. 267 - 274
Issue Date:: 2017-11-01

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Field	Value	Language
dc.contributor.author	Sanderson, E	en_US
dc.contributor.author	Yeo, KT	en_US
dc.contributor.author	Wang, AY https://orcid.org/0000-0002-3656-4284	en_US
dc.contributor.author	Callander, I	en_US
dc.contributor.author	Bajuk, B	en_US
dc.contributor.author	Bolisetty, S	en_US
dc.contributor.author	Lui, K	en_US
dc.contributor.author	Bowen, J	en_US
dc.contributor.author	Sedgley, S	en_US
dc.contributor.author	Carlisle, H	en_US
dc.contributor.author	Kent, A	en_US
dc.contributor.author	Smith, J	en_US
dc.contributor.author	Craven, P	en_US
dc.contributor.author	Cruden, L	en_US
dc.contributor.author	Argomand, A	en_US
dc.contributor.author	Rieger, I	en_US
dc.contributor.author	Malcolm, G	en_US
dc.contributor.author	Lutz, T	en_US
dc.contributor.author	Reid, S	en_US
dc.contributor.author	Stack, J	en_US
dc.contributor.author	Medlin, K	en_US
dc.contributor.author	Marcin, K	en_US
dc.contributor.author	Shingde, V	en_US
dc.contributor.author	Chin, MF	en_US
dc.contributor.author	Bonzer, K	en_US
dc.contributor.author	Badawi, N	en_US
dc.contributor.author	Halliday, R	en_US
dc.contributor.author	Karskens, C	en_US
dc.contributor.author	Paradisis, M	en_US
dc.contributor.author	Kluckow, M	en_US
dc.contributor.author	Jacobs, C	en_US
dc.contributor.author	Numa, A	en_US
dc.contributor.author	Williams, G	en_US
dc.contributor.author	Young, J	en_US
dc.contributor.author	Luig, M	en_US
dc.contributor.author	Baird, J	en_US
dc.contributor.author	Oei, JL	en_US
dc.contributor.author	Cameron, D	en_US
dc.date.available	2017-06-18	en_US
dc.date.issued	2017-11-01	en_US
dc.identifier.citation	Journal of Hospital Infection, 2017, 97 (3), pp. 267 - 274	en_US
dc.identifier.issn	0195-6701	en_US
dc.identifier.uri	http://hdl.handle.net/10453/124269
dc.description.abstract	© 2017 The Healthcare Infection Society Background Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). Aim To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. Methods The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). Findings There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan–Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12–20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. Conclusion There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.	en_US
dc.relation.ispartof	Journal of Hospital Infection	en_US
dc.relation.isbasedon	10.1016/j.jhin.2017.06.023	en_US
dc.subject.classification	Epidemiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Sepsis	en_US
dc.subject.mesh	Catheterization, Central Venous	en_US
dc.subject.mesh	Incidence	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Time Factors	en_US
dc.subject.mesh	Infant, Newborn	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Catheter-Related Infections	en_US
dc.title	Dwell time and risk of central-line-associated bloodstream infection in neonates	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	97	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	97	en_US

Abstract:

© 2017 The Healthcare Infection Society Background Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). Aim To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. Methods The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). Findings There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan–Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12–20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. Conclusion There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.

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