Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience.
OBJECTIVE
To monitor trends in central line-associated bloodstream infections and clinical sepsis (CLABICS) among neonates and to determine risk factors for infection, especially dwell time.


METHODS
Prospective, single-center cohort study conducted from 2001 through 2008.


METHODS
University-affiliated tertiary care center.


METHODS
Individualized surveillance of catheter use and CLABICS episodes was conducted. Data were obtained via regular on-site visits made 3 times a week. Trends over time were estimated by Poisson regression, and risk factor analysis was conducted using a Cox proportional hazards model and logistic regression.


RESULTS
In all, 1,124 neonates were exposed to 2,210 central lines for a total of 12,746 catheter-days and 11,467 catheter-days at risk. The median duration of catheter use was 8 (interquartile range, 5-11) days for peripherally inserted central catheters (PICCs) and 4 (interquartile range, 2-6) days for umbilical catheters; 102 CLABICS episodes were detected. The median time to infection was 7 days. Incidence densities were 8.5 CLABICS episodes per 1,000 catheter-days at risk and 8.0 CLABICS episodes per 1,000 catheter-days. The highest rates were identified among neonates weighing 750 g or lower (14.9 CLABICS episodes per 1,000 catheter days at risk) and for PICCs (13.2 CLABICS episodes per 1,000 catheter days at risk). Catheter dwell time was associated with CLABICS for all umbilical catheters (odds ratio [OR], 1.2 per day of use [95% confidence interval {CI}, 1.1-1.3]; P < .001) and for PICCs for up to 7 days (OR, 1.2 [95% CI, 1.1-1.4]; P = .041), but not thereafter (OR, 1.0 [95% CI, 0.9-1.1]; P = .90).


CONCLUSIONS
Catheter dwell time is a risk factor for CLABICS during the first 7 days, irrespective of catheter type. After 7 days, PICCs are less likely to become infected.
University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Walter
W
Zingg
Klara M
KM
Posfay-Barbe
Riccardo E
RE
Pfister
Sylvie
S
Touveneau
Didier
D
Pittet
D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016012:Poisson Distribution; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology; D013557:Switzerland / Q000453:epidemiology