title: Central venous catheter-associated bloodstream infections in a pediatric intensive care unit: effect of the location of catheter insertion.
abstract: OBJECTIVE
  To compare the rate of central venous catheter-associated bloodstream infections between pediatric intensive care unit admissions where central venous catheters were inserted within the same hospital (internal central venous catheters) and those where central venous catheters were inserted before transfer from other hospitals (external central venous catheters).
  
  
  METHODS
  Retrospective analysis of prospectively collected data.
  
  
  METHODS
  A tertiary care pediatric intensive care unit in London, UK.
  
  
  METHODS
  Consecutive pediatric intensive care unit admissions between May 2007 and March 2009.
  
  
  METHODS
  None.
  
  
  RESULTS
  Catheter-associated bloodstream infections were identified using a widely accepted surveillance definition. The rate and time to occurrence of catheter-associated bloodstream infection were compared between internal and external nontunneled central venous catheters. A multilevel Cox-regression model was used to study the association between location of central venous catheter insertion and time to catheter-associated bloodstream infection. In total, 382 central venous catheters were studied (245 internal; 137 external) accounting for a total of 1,737 central venous catheter days. There was a higher catheter-associated bloodstream infection incidence density among external central venous catheters (23.1 [95% confidence interval 11.0-35.2] vs. 9.7 [95% confidence interval 3.9-15.5] per 1,000 catheter-days). Multivariable analyses demonstrated higher infection risk with external central venous catheters (hazard ratio 2.65 [95% confidence interval 1.18-5.96]) despite adjustment for confounding variables.
  
  
  CONCLUSIONS
  The rate of catheter-associated bloodstream infections in the pediatric intensive care unit is significantly affected by external insertion of the central venous catheter. Future interventions to reduce nosocomial infections on pediatric intensive care units will need to be specifically targeted at this high-risk patient group.
authors.affiliation: Paediatric Intensive Care Unit, Children's Acute Transport Service, Great Ormond Street Hospital, London, UK.
authors.forename: Anil
authors.initials: A
authors.lastname: Krishnaiah
authors.forename: James
authors.initials: J
authors.lastname: Soothill
authors.forename: Angie
authors.initials: A
authors.lastname: Wade
authors.forename: Quen Q
authors.initials: QQ
authors.lastname: Mok
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Ramnarayan
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D015999:Multivariate Analysis; D010360:Patient Transfer; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors