title: Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.
abstract: BACKGROUND
  Repair of broken central venous catheters (CVCs) is common in pediatric patients. We hypothesized that this practice predisposes to bacteremia and central line-associated bloodstream infections (CLABSI).
  
  
  METHODS
  We conducted a retrospective case-crossover study of pediatric patients 1 month to 21 years of age with CVC breakages who underwent a first-time repair at our institution, using repair kits provided by CVC manufacturers. We compared rates of bacteremia and CLABSI (defined by Centers for Disease Control and Prevention criteria) in the 30 days prerepair (control period) and the 30 days postrepair (exposure period), with adjustment for within-patient correlation using conditional Poisson regression.
  
  
  RESULTS
  The mean prerepair rate of bacteremia was 9.9 per 1000 catheter-days, which increased to 24.5 postrepair, resulting in an adjusted incidence rate ratio (IRR) of 1.87 (95% CI: 1.05-3.33, P = 0.034). Risk of CLABSI demonstrated a greater than 2-fold increase (IRR: 2.15, 95% CI: 1.02-4.53, P = 0.045) when all catheter-days were included, and a 4-fold increase when days on antibiotics were excluded (IRR: 4.07, 95% CI: 1.43-11.57, P = 0.008).
  
  
  CONCLUSIONS
  We found that repair of a broken CVC was associated with a 2- to 4-fold higher risk of developing CLABSI within 30 days of repair in pediatric patients. Further studies are needed to determine interventions to reduce this risk and to better define the relative merits of CVC repair compared with replacement in selected patient populations.
authors.affiliation: Division of Pediatric Infectious Diseases, Seattle Children's Hospital, Seattle, WA 98105, USA.
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Lundgren
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.forename: Frances R
authors.initials: FR
authors.lastname: Malone
authors.forename: Nancy G
authors.initials: NG
authors.lastname: McAfee
authors.forename: Soren
authors.initials: S
authors.lastname: Gantt
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology*; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult