Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study.
OBJECTIVE
To determine whether the daily risk of central line-associated bloodstream infections (CLABSIs) increases over the dwell time of peripherally inserted central catheters (PICCs) in high-risk neonates.


METHODS
Multicenter retrospective cohort including NICU patients with a PICC inserted between January 2005 and June 2010. We calculated incidence rates and used Poisson regression models to assess the risk of developing CLABSI as a function of PICC dwell time.


RESULTS
A total of 4797 PICCs placed in 3967 neonates were included; 149 CLABSIs occurred over 89,946 catheter-days (incidence rate 1.66 per 1000 catheter-days). In unadjusted analysis, PICCs with a dwell time of 8 to 13 days, 14 to 22 days, and ≥23 days each had an increased risk of infection compared with PICCs in place for ≤7 days (P < .05). In adjusted analysis, the average predicted daily risk of CLABSIs after PICC insertion increased during the first 2 weeks after PICC insertion and remained elevated for the dwell time of the catheter. There was an increased risk of CLABSIs in neonates with concurrent PICCs (adjusted incidence rate ratio 2.04, 1.12-3.71). The incidence of Gram-negative CLABSIs was greater in PICCs with dwell times >50 days (incidence rate ratio 5.26, 2.40-10.66).


CONCLUSIONS
The risk of CLABSIs increased during the 2 weeks after PICC insertion and then remained elevated until PICC removal. Clinicians should review PICC necessity daily, optimize catheter maintenance practices, and investigate novel CLABSI prevention strategies in PICCs with prolonged dwell times.
MHS, JHU Department of Pediatric Infectious Diseases, 200 North Wolfe St, Rubenstein 3141, Baltimore, MD 21287. amilsto1@jhmi.edu.
Aaron M
AM
Milstone
Nicholas G
NG
Reich
Sonali
S
Advani
Guoshu
G
Yuan
Kristina
K
Bryant
Susan E
SE
Coffin
W Charles
WC
Huskins
Robyn
R
Livingston
Lisa
L
Saiman
P Brian
PB
Smith
Xiaoyan
X
Song
D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods*; D008297:Male; D016012:Poisson Distribution; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
NICU; catheter-related infections; central venous catheters; infection; peripheral venous catheterization