Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants.
OBJECTIVE
Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagulase-negative staphylococci sepsis, which may be prevented by the short-term administration of an anti-staphylococcal agent during the procedure of removal. The administration of a specific anti-staphylococcal agent (cefazolin) was evaluated for the prevention of central venous catheter removal-associated coagulase-negative staphylococci sepsis.


METHODS
A prospective, open, randomized, controlled intervention study.


METHODS
Twenty-eight-bed neonatal intensive care unit at a tertiary care children's hospital.


METHODS
Eighty-eight preterm infants (gestational age <37 wks) admitted to the neonatal intensive care unit with indwelling percutaneously inserted central venous catheters.


METHODS
From April 2007 to January 2010, infants were randomized to receive two doses of cefazolin during removal of the percutaneously inserted central venous catheter (intervention group, n = 44) or no antimicrobial agent (control group, n = 44). Percutaneously inserted central venous catheter removal-associated sepsis was defined as sepsis occurring <48 hrs after removal of the percutaneously inserted central venous catheter.


RESULTS
Clinical characteristics and central venous catheter duration did not show differences between both groups. Five infants (11%) of the control group developed coagulase-negative staphylococci sepsis <48 hrs after removal of the percutaneously inserted central venous catheter compared to none (0%) in the intervention group (p = .021).


CONCLUSIONS
Two doses of the anti-staphylococcal agent cefazolin during the procedure of removal of a percutaneously inserted central venous catheter were effective in the prevention of coagulase-negative staphylococci sepsis. It is recommended to include this regimen in the guidelines on management of central venous catheters in very-low-birth-weight infants.
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands. M.A.C.Hemels@umcutrecht.nl
Marieke A C
MA
Hemels
Agnes
A
van den Hoogen
Malgorzata A
MA
Verboon-Maciolek
André
A
Fleer
Tannette G
TG
Krediet
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D002437:Cefazolin / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D002437:Cefazolin