title: Incidence of catheter-related bloodstream infections in neonates following removal of peripherally inserted central venous catheters.
abstract: OBJECTIVE
  Catheter-associated bloodstream infections are a significant source of morbidity and healthcare cost in the neonatal ICU. Previous studies examining the prevalence of bloodstream infections after removal of peripherally inserted central venous catheters in neonates are equivocal.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  All infants with peripherally inserted central venous catheters treated at the Vanderbilt neonatal ICU between 2007 and 2009.
  
  
  RESULTS
  We evaluated the following outcomes: 1) bloodstream infections, 2) culture-negative sepsis, 3) number of sepsis evaluations, and 4) number of significant apnea/bradycardia events comparing odds ratios between 72 hours before and 72 hours after peripherally inserted central venous catheter removal. We analyzed a total of 1,002 peripherally inserted central venous catheters in 856 individual infants with a median (interquartile range) gestational age of 31 weeks (28-37 wk) and a median birth weight of 1,469 g (960-2,690 g). Comparing 72 hours before with 72 hours after peripherally inserted central venous catheter removal did not show a difference in the prevalence of bloodstream infections (9 vs 3, p = 0.08), prevalence of culture-negative sepsis (37 vs 40, p = 0.73), number of sepsis evaluations (p = 0.42), or number of apnea/bradycardia events (p = 0.32). However, in peripherally inserted central venous catheter not used for delivery of antibiotics, there was a 3.83-fold increase in odds for culture-negative sepsis following peripherally inserted central venous catheter removal (95% confidence interval, 1.48-10.5; p = 0.001). For infants less than 1,500 g birth weight (very low birth weight), odds for culture-negative sepsis increased to 6.3-fold following removal of peripherally inserted central venous catheters not used for antibiotic delivery (95% confidence interval, 1.78-26.86; p < 0.01).
  
  
  CONCLUSIONS
  Although these data do not support the routine use of antibiotics for sepsis prophylaxis prior to peripherally inserted central venous catheter removal, they suggests that very low birth weight infants not recently exposed to antibiotics are at increased odds for associated adverse events following discontinuation of their peripherally inserted central venous catheter.
authors.affiliation: 1Vanderbilt University School of Medicine, Nashville, TN. 2Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, TN. 3Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Michael
authors.initials: M
authors.lastname: Casner
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Hoesli
authors.forename: James C
authors.initials: JC
authors.lastname: Slaughter
authors.forename: Melissa
authors.initials: M
authors.lastname: Hill
authors.forename: Jörn-Hendrik
authors.initials: JH
authors.lastname: Weitkamp
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001049:Apnea / Q000453:epidemiology / Q000209:etiology; D001724:Birth Weight; D001919:Bradycardia / Q000453:epidemiology / Q000209:etiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D015995:Prevalence; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin