title: Outcomes associated with early removal versus retention of peripherally inserted central catheters after diagnosis of catheter-associated infections in neonates.
abstract: OBJECTIVE
  To compare clinical outcomes and hospital resource utilization of infants who had peripherally inserted central catheters removed early versus retained following diagnosis of central line-associated bloodstream infection.
  
  
  METHODS
  In a single centre retrospective cohort study, we compared outcomes of infants who had peripherally inserted central catheters removed early versus retained after diagnosis of central line-associated bloodstream infection. Mortality, cardio-respiratory deterioration, use of blood products and antibiotics were compared between groups.
  
  
  RESULTS
  Over a 10-year period, of the 119 eligible infants, 38 had peripherally inserted central catheters removed early and 81 had catheters retained after diagnosis of central line-associated bloodstream infection. Baseline demographics, illness severity at onset of sepsis and distribution of organisms were similar between the groups. Infants in "catheter-retained" group required longer antibiotic usage (17 ± 9 versus 13 ± 6 days; p = 0.025) and more frequent sequential positive blood cultures [31/81 (47%) versus 8/38 (22%), p = 0.014). Infants with Gram-negative bacteremia demonstrated higher mortality when catheters were retained [43% (9/21) versus 7% (1/14); p = 0.028].
  
  
  CONCLUSIONS
  Retaining peripherally inserted central catheters after diagnosis of central line-associated bloodstream infection was associated with longer duration of bacteremia and prolonged exposure to systemic antibiotics as well as increased mortality in Gram-negative bacteremia.
authors.affiliation: a Department of Pediatrics , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada.
authors.forename: Poorva
authors.initials: P
authors.lastname: Deshpande
authors.affiliation: a Department of Pediatrics , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada.
authors.forename: Amish
authors.initials: A
authors.lastname: Jain
authors.affiliation: a Department of Pediatrics , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D000071074:Neonatal Sepsis / Q000175:diagnosis / Q000401:mortality; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Central line-associated bloodstream infection; neonatal nosocomial infections; peripherally inserted central catheters