title: Catheter management in neonates with bloodstream infection and a percutaneously inserted central venous catheter in situ: removal or not?
abstract: BACKGROUND
  This study investigated whether removal of a percutaneously inserted central venous catheter (PICC) is compulsory in neonates with bloodstream infection (BSI), and also examined the risk factors for infectious complications when a PICC is retained in these patients.
  
  
  METHODS
  This was a cohort study of neonates with a PICC who developed a BSI between 2001 and 2007. BSI was defined according to Centers for Disease Control and Prevention criteria.
  
  
  RESULTS
  Of the 234 neonates in the cohort, 99 had early removal of PICC (ER-PICC, defined as removal within 3 days after the onset of clinical sepsis), and 135 had late removal of PICC (LR-PICC, defined as retention for more than 3 days after the onset of clinical sepsis). Resolution of clinical sepsis within 2 days was more frequent in the ER-PICC group compared with the LR-PICC group (80.8% vs 57.8%; P < .001). There was no significant difference between the 2 groups in terms of infectious complications and case fatalities, but the LR-PICC group had a significantly higher incidence of recurrence within 1 month after BSI (P = .002). Inappropriate initial antibiotic treatment was the only variable independently associated with infectious complications (odds ratio, 11.4; 95% confidence interval, 3.34∼39.2; P < .001).
  
  
  CONCLUSIONS
  PICCs should be removed in neonates with BSI, because retention of PICCs for more than 3 days is associated with delayed resolution of clinical sepsis and a higher incidence of recurrence within 1 month.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.forename: Hsuan-Rong
authors.initials: HR
authors.lastname: Huang
authors.forename: Chiao-Ching
authors.initials: CC
authors.lastname: Chiang
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.forename: Hwey-Fang
authors.initials: HF
authors.lastname: Liang
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D055499:Catheter-Related Infections / Q000401:mortality / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D055502:Secondary Prevention; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D028761:Withholding Treatment