title: Risk factors for central venous catheter-related infections in pediatric intensive care.
abstract: OBJECTIVE
  To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection.
  
  
  METHODS
  After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve.
  
  
  RESULTS
  Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular) was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014) and duration of catheter use (p=0.0013), and protective factors included concomitant antibiotic use (p=0.0005) and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002). Pediatric Risk of Mortality did not discriminate the risk of infection.
  
  
  CONCLUSIONS
  Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.
authors.affiliation: State University of Campinas (UNICAMP) - Clinical Hospital, Pediatric Intensive Care Unit. ricardovilela@superig.com.br
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vilela
authors.forename: Andréa D N
authors.initials: AD
authors.lastname: Jácomo
authors.forename: Antonia Teresinha
authors.initials: AT
authors.lastname: Tresoldi
mesh_terms: D041022:Candida tropicalis / Q000302:isolation & purification; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002675:Child, Preschool; D003428:Cross Infection / Q000382:microbiology*; D004754:Enterobacter / Q000302:isolation & purification; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D013212:Staphylococcus epidermidis / Q000302:isolation & purification