title: Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study.
abstract: OBJECTIVE
  Analysis of infectious complications and risk factors in percutaneous central venous catheters.
  
  
  METHODS
  One-year observational, prospective, multicenter study (1998-1999).
  
  
  METHODS
  Twenty Spanish pediatric intensive care units.
  
  
  METHODS
  Eight hundred thirty-two children aged 0-14 years.
  
  
  METHODS
  None.
  
  
  RESULTS
  One thousand ninety-two catheters were analyzed. Seventy-four (6.81%) catheter-related bloodstream infections (CRBSI) were found. The CRBSI rate was 6.4 per 1,000 CVC days (95% CI 5.0-8.0). Risk factors for CRBSI were weight under 8 kg (p < 0.001), cardiac failure (RR 2.69; 95% CI 1.95-4.38; p < 0.001), cancer (RR 1.66; 95% CI 0.97-2.78; p=0.05), silicone catheters (RR 2.82; 95% CI 1.49-5.35; p = 0.006), guidewire exchange catheterization (p=0.002), obstructed catheters (RR 2.67; 95% CI 1.63-4.39; p<0.001), and more than 12 days' indwelling time (RR 5.9; 95% CI 3.63-9.41; p<0.001). Multivariate Cox regression identified lower patient weight (HR 2.4; 95% CI 1.11-5.19; p=0.002), guidewire exchange catheterization (HR 2.2; 95% CI 1.07-4.54; p=0.049) and more than 12 days' indwelling time (HR 1.97; 95% CI 0.89-4.36; p=0.089) as significant independent predictors of CRBSI. Factors which protected against infection were the use of povidone-iodine on hubs (HR 0.42; 95% CI 0.19-0.96; p=0.025) and porous versus impermeable dressing (HR 0.41; 95% CI 0.23-0.74; p=0.004). Two children (0.24%) died from endocarditis following catheter-related sepsis due to Stenotrophomonas maltophilia in one case and P. aeruginosa in the other.
  
  
  CONCLUSIONS
  Catheter-related sepsis is associated with lower patient weight and more than 12 days' indwelling time, but not with the insertion site. Cleaning hubs with povidone-iodine protects from infection.
authors.affiliation: Pediatric Intensive Care Unit, Hospital Niño Jesús, C/ Menéndez Pelayo, 65, 28009, Madrid, Spain.
authors.forename: M Angeles
authors.initials: MA
authors.lastname: García-Teresa
authors.forename: Juan
authors.initials: J
authors.lastname: Casado-Flores
authors.forename: M Angel
authors.initials: MA
authors.lastname: Delgado Domínguez
authors.forename: Jorge
authors.initials: J
authors.lastname: Roqueta-Mas
authors.forename: Francisco
authors.initials: F
authors.lastname: Cambra-Lasaosa
authors.forename: Andrés
authors.initials: A
authors.lastname: Concha-Torre
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández-Pérez
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D013030:Spain / Q000453:epidemiology