Central venous catheter bloodstream infections in the neonatal intensive care unit

• Published in: Journal of pediatric surgery 1998-09, Vol.33 (9), p.1383-1387
• Main Authors: Fallat, Mary E., Gallinaro, Robert N., Stover, Beth H., Wilkerson, Shirley, Jane Goldsmith, L.
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Bacteremia - drug therapy; Bacteremia - etiology; Biological and medical sciences; Blood - microbiology; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - methods; Catheters, Indwelling; Chi-Square Distribution; Cohort Studies; Emergency and intensive care: techniques, logistics; Humans; Infant, Newborn; Intensive care medicine; Intensive Care Units, Neonatal; Logistic Models; Medical sciences; Perfusions. Catheterizations. Hyperbaric oxygenotherapy; Retrospective Studies; Statistics, Nonparametric; Survival Analysis; Vancomycin - therapeutic use
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(98)90013-6

Purpose: The goal of this study was to identify symptoms and signs related to central venous catheter (CVC) bloodstream infections (BSI) in neonatal intensive care unit (NICU) patients that would predict infection and to identify factors that might influence CVC longevity. Methods: This was a retrospective cohort study evaluating 268 lines representing a total of 5,212 CVC days placed in 157 NICU patients over 29 months by the pediatric surgery and neonatology services at one children's hospital. Centers for Disease Control (CDC) criteria were used to determine laboratory-confirmed BSI. Data were analyzed by univariate methods and logistic regression and determined significant at the P less than .05 level. Results: Sixty-five lines (24%) from 54 patients had confirmed CVC BSI. Fever (49%) and pulmonary dysfunction (30%) were the most common symptoms of CVC BSI. Erythema or purulent discharge at the insertion site was found in only 20% of cases. Staphylococcus epidermidis was the most common organism isolated. Factors that significantly decreased the incidence of CVC BSI were increasing estimated gestational age (EGA; P < .0013) at time of insertion, associated vancomycin use at the time of catheter placement ( P < .0057), and fewer days of catheter use ( P < .0291). There were no significant differences noted caused by line location or catheter type. Conclusion: Fever and pulmonary dysfunction were the most common signs of CVC BSI in neonates. Lower EGA and increased catheter duration were significantly correlated with infection. The use of vancomycin concurrent with catheter insertion was associated with a decreased incidence of CVC BSI, however concerns regarding the emergence of vancomycin-resistant organisms preclude support of its use as a prophylactic agent.