title: Increased frequency of peripheral venipunctures raises the risk of central-line associated bloodstream infection in neonates with peripherally inserted central venous catheters.
abstract: OBJECTIVE
  Central-line associated bloodstream infection (CLA-BSI), which is mostly caused by coagulase-negative staphylococcus, is an important morbidity in neonatal intensive care units. Our study is aimed to identify the risk factors of CLA-BSI in neonates with peripherally inserted central venous catheters (PICCs).
  
  
  METHODS
  A retrospective cohort study of neonatal intensive care unit patients with a PICC insertion between January 1, 2011 and December 31, 2012 was conducted. We performed univariate and multivariate analyses with a logistic regression model to investigate the risk factors and the association between increased frequency of peripheral venipunctures during PICC use and the risk of CLA-BSI while adjusting for other variables.
  
  
  RESULTS
  There were 123 neonates included in our study. Thirteen CLA-BSIs were recorded within the follow-up period. The incidence of PICC-associated CLA-BSI was 4.99 per 1000 catheter-days. There was no statistically significant association between the risk of CLA-BSI and gestational age, birth weight, chronological age, or other comorbidities. However, the odds of CLS-BSI increased to 12 times if the patient received six or more venipunctures within the period without concurrent antibiotic use [odds ratio (OR), 11.94; p < 0.001]. The OR of CLA-BSIs increased by 16% per venipuncture during PICC use (OR, 1.14; p = 0.003).
  
  
  CONCLUSIONS
  During PICC use, increased frequency of venipunctures, especially when there was no concurrent antibiotic use, substantially raises the risk of CLA-BSI. By decreasing unnecessary venipunctures during PICC use, PICC-associated CLA-BSI and further morbidities and mortalities can be prevented.
authors: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Hao-Yuan
authors: HY
authors: Cheng
authors: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Chun-Yi
authors: CY
authors: Lu
authors: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Li-Min
authors: LM
authors: Huang
authors: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Ping-Ing
authors: PI
authors: Lee
authors: Department of Laboratory Medicine, National Taiwan University Hospital, Taiwan.
authors: Jong-Min
authors: JM
authors: Chen
authors: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: ly7077@tpts6.seed.net.tw.
authors: Luan-Yin
authors: LY
authors: Chang
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology*; D062905:Central Venous Catheters / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D018962:Phlebotomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*
keywords: bloodstream infection; catheter-related infection; neonatal intensive care unit; peripherally inserted central venous catheter