title: Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis.
abstract: BACKGROUND
  Clinical signs of sepsis are frequently observed after removal of a percutaneously inserted central venous catheter (PCVC) in neonates admitted at our Neonatal Intensive Care Unit (NICU). To substantiate this finding and to evaluate the effect of antibiotics administered at the time of removal of a PCVC, we conducted a retrospective study among all infants with a PCVC, admitted at our NICU during 2002 and 2005.
  
  
  METHODS
  Clinical data, infectious complications and use of antibiotics were studied retrospectively.
  
  
  RESULTS
  A PCVC was inserted in 345 infants. Sepsis occurred in 90/345 (26%) infants, in 50/90 (56%) during indwelling PCVC and in 40/90 (44%) after removal of the PCVC. Of the latter 40 sepsis episodes, 24 (60%) occurred within 5 days after removal of a PCVC with a clustering of 21 cases of sepsis within 72 h after the removal. The remaining 16 episodes occurred after 7 days. Administration of antibiotics during removal of the PCVC significantly reduced the incidence of sepsis: 22/213 (10.3%) cases of sepsis occurred when no antibiotics were administered versus 2/132 (1.5%) cases of sepsis when antibiotics were administered (p = 0.002).
  
  
  CONCLUSIONS
  Our study suggests that peripherally inserted central venous catheters are associated with sepsis not only during the indwelling period of the catheter, but also after removal. Administration of antibiotics targeted at the time of removal of the catheter significantly reduced the incidence of sepsis. Future prospective studies are warranted to confirm this observation.
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van den Hoogen
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: Brouwer
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Gerards
authors.forename: André
authors.initials: A
authors.lastname: Fleer
authors.forename: Tannette G
authors.initials: TG
authors.lastname: Krediet
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D002437:Cefazolin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002437:Cefazolin