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Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis

Ricardo Silveira Yamaguchi| Danilo Teixeira Noritomi| Natalia Viu Degaspare| Gabriela Ortega Cisternas Muñoz| Ana Paula Matos Porto| Silvia Figueiredo Costa| Otavio T. Ranzani
Original
Volume 43, Issue 8 / August , 2017

Pages 1097 - 1104

Abstract

Purpose

Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children.

Methods

We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil. We included patients aged 0–14 years, who needed a CVC or PICC during a PICU stay from January 2013 to December 2015. Our primary endpoint was CLABSI up to 30 days after catheter placement. We defined CLABSI based on the Center for Disease Control and Prevention’s National Healthcare Safety Networks (NHSN) 2015 surveillance definitions. To account for potential confounders, we used propensity scores with inverse probability weighting.

Results

A total of 1660 devices (922 PICCs and 738 CVCs) in 1255 children were included. The overall CLABSI incidence was 2.28 (95% CI 1.70–3.07)/1000 catheter-days. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR 2.20, 95% CI 1.05–4.61; p = 0.037) compared with PICCs. In a sensitivity analysis, CVCs remained associated with higher risk of CLABSI (adjHR 2.18, 95% CI 1.02–4.64; p = 0.044) after adding place of insertion and use of parenteral nutrition to the model as a time-dependent variable.

Conclusions

PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention.

Keywords

References

  1. Edwards JD, Herzig CT, Liu H et al (2015) Central line–associated blood stream infections in pediatric intensive care units: longitudinal trends and compliance with bundle strategies. Am J Infect Control 43:489–493. doi:10.1016/j.ajic.2015.01.006
    • View reference on publisher's website
    • View reference on PubMed
  2. Randolph AG (2016) Pragmatic trials in critically ill children are CATCHing on. Lancet 387:1697–1698. doi:10.1016/S0140-6736(16)00566-3
    • View reference on publisher's website
    • View reference on PubMed
  3. Nowak JE, Brilli RJ, Lake MR et al (2010) Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: business case for quality improvement. Pediatr Crit Care Med 11:579–587. doi:10.1097/PCC.0b013e3181d90569
    • View reference on publisher's website
    • View reference on PubMed
  4. Blot SI, Depuydt P, Annemans L et al (2005) Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 41:1591–1598
    • View reference on publisher's website
    • View reference on PubMed
  5. Gibson C, Connolly BL, Moineddin R et al (2013) Peripherally inserted central catheters: use at a tertiary care pediatric center. J Vasc Interv Radiol 24:1323–1331. doi:10.1016/j.jvir.2013.04.010
    • View reference on publisher's website
    • View reference on PubMed
  6. Maki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81:1159–1171. doi:10.4065/81.9.1159
    • View reference on publisher's website
    • View reference on PubMed
  7. Safdar N, Maki DG (2005) Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 128:489–495. doi:10.1378/chest.128.2.489
    • View reference on publisher's website
    • View reference on PubMed
  8. Chopra V, O’Horo JC, Rogers MAM et al (2013) The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 34:908–918. doi:10.1086/671737
    • View reference on publisher's website
    • View reference on PubMed
  9. Soares M, Bozza FA, Angus DC et al (2015) Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Med 41:2149–2160. doi:10.1007/s00134-015-4076-7
  10. Ranzani OT, Simpson ES, Augusto TB et al (2014) Evaluation of a minimal sedation protocol using ICU sedative consumption as a monitoring tool: a quality improvement multicenter project. Crit Care 18:580. doi:10.1186/s13054-014-0580-3
    • View reference on publisher's website
    • View reference on PubMed
  11. How-to Guide: Prevent Central Line-Associated Bloodstream Infections. Cambridge, MA: Institute for Healthcare Improvement; 2012. (Available at https://www.ihi.org)
  12. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and non-central line-associated Bloodstream Infection)—Device associated module. Updated January 2017. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf:
  13. Austin PC (2014) The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments: propensity scores and survival analysis. Stat Med 33:1242–1258. doi:10.1002/sim.5984
    • View reference on publisher's website
    • View reference on PubMed
  14. Truche A-S, Darmon M, OUTCOMEREA Study Group et al (2016) Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery. Intensive Care Med 42:1408–1417. doi:10.1007/s00134-016-4404-6
  15. Pages J, Hazera P, 3SITES Study Group et al (2016) Comparison of alcoholic chlorhexidine and povidone–iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study. Intensive Care Med 42:1418–1426. doi:10.1007/s00134-016-4406-4
  16. Wyss R, Ellis AR, Brookhart MA et al (2014) The role of prediction modeling in propensity score estimation: an evaluation of logistic regression, bCART, and the covariate-balancing propensity score. Am J Epidemiol 180:645–655. doi:10.1093/aje/kwu181
    • View reference on publisher's website
    • View reference on PubMed
  17. Imai K, Ratkovic M (2014) Covariate balancing propensity score. J R Stat Soc B 76:243–263. doi:10.1111/rssb.12027
    • View reference on publisher's website
  18. Brookhart MA (2006) Variable selection for propensity score models. Am J Epidemiol 163:1149–1156. doi:10.1093/aje/kwj149
    • View reference on publisher's website
    • View reference on PubMed
  19. Arpino B, Cannas M (2016) Propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the Apgar score: propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the Apgar score. Stat Med 35:2074–2091. doi:10.1002/sim.6880
    • View reference on publisher's website
    • View reference on PubMed
  20. Cole SR, Hernán MA (2004) Adjusted survival curves with inverse probability weights. Comput Methods Progr Biomed 75:45–49. doi:10.1016/j.cmpb.2003.10.004
    • View reference on publisher's website
  21. Parienti J-J, Mongardon N, Mégarbane B et al (2015) Intravascular complications of central venous catheterization by insertion site. N Engl J Med 373:1220–1229. doi:10.1056/NEJMoa1500964
    • View reference on publisher's website
    • View reference on PubMed
  22. Dudeck MA, Edwards JR, Allen-Bridson K et al (2015) National healthcare safety network report, data summary for 2013, device-associated module. Am J Infect Control 43:206–221. doi:10.1016/j.ajic.2014.11.014
    • View reference on publisher's website
    • View reference on PubMed
  23. Fontela PS, Platt RW, Rocher I et al (2012) Epidemiology of central line–associated bloodstream infections in Quebec intensive care units: a 6-year review. Am J Infect Control 40:221–226. doi:10.1016/j.ajic.2011.04.008
    • View reference on publisher's website
    • View reference on PubMed
  24. Miller MR, Niedner MF, Huskins WC et al (2011) Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics 128:e1077–e1083. doi:10.1542/peds.2010-3675
    • View reference on publisher's website
    • View reference on PubMed
  25. Patrick SW, Kawai AT, Kleinman K et al (2014) Health care-associated infections among critically ill children in the US, 2007–2012. Pediatrics 134:705–712
    • View reference on publisher's website
    • View reference on PubMed
  26. Rosenthal VD, Al-Abdely HM, El-Kholy AA et al (2016) International nosocomial infection control consortium report, data summary of 50 countries for 2010–2015: device-associated module. Am J Infect Control 44:1495–1504. doi:10.1016/j.ajic.2016.08.007
    • View reference on publisher's website
    • View reference on PubMed
  27. Leblebicioglu H, Erben N, Rosenthal VD et al (2014) International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003–2012. Ann Clin Microbiol Antimicrob 13:1
    • View reference on publisher's website
  28. Rosenthal VD (2009) Central line-associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 49:1899–1907. doi:10.1086/648439
    • View reference on publisher's website
    • View reference on PubMed
  29. Marschall J, Mermel LA, Fakih M et al (2014) Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35:753–771. doi:10.1086/676533
    • View reference on publisher's website
    • View reference on PubMed
  30. O’Grady NP, Alexander M, Dellinger EP et al (2002) Guidelines for the prevention of intravascular catheter-related infections. Pediatrics 110:e51. doi:10.1542/peds.110.5.e51
    • View reference on publisher's website
    • View reference on PubMed
  31. Advani S, Reich NG, Sengupta A et al (2011) Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis 52:1108–1115. doi:10.1093/cid/cir145
    • View reference on publisher's website
    • View reference on PubMed
  32. Jumani K, Advani S, Reich NG et al (2013) Risk factors for peripherally inserted central venous catheter complications in children. JAMA Pediatr 167:429. doi:10.1001/jamapediatrics.2013.775
    • View reference on publisher's website
    • View reference on PubMed
  33. Gilbert RE, Mok Q, Dwan K et al (2016) Impregnated central venous catheters for prevention of bloodstream infection in children (the CATCH trial): a randomised controlled trial. Lancet 387:1732–1742
    • View reference on publisher's website
    • View reference on PubMed
  34. Goes-Silva E, Abreu TF, Frota ACC et al (2009) Use of peripherally inserted central catheters to prevent catheter-associated bloodstream infection in children. Infect Control Hosp Epidemiol 30:1024–1026. doi:10.1086/606040
    • View reference on publisher's website
    • View reference on PubMed
  35. Al Raiy B, Fakih MG, Bryan-Nomides N et al (2010) Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. Am J Infect Control 38:149–153. doi:10.1016/j.ajic.2009.06.008
    • View reference on publisher's website
    • View reference on PubMed
  36. Hord JD, Lawlor J, Werner E et al (2016) Central line associated blood stream infections in pediatric hematology/oncology patients with different types of central lines: cLABSI in patients with different central line types. Pediatr Blood Cancer 63:1603–1607. doi:10.1002/pbc.26053
    • View reference on publisher's website
    • View reference on PubMed
  37. Safdar N, Maki DG (2004) The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 30:62–67. doi:10.1007/s00134-003-2045-z
  38. Chopra V, Ratz D, Kuhn L et al (2014) PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 127:319–328. doi:10.1016/j.amjmed.2014.01.001
    • View reference on publisher's website
    • View reference on PubMed
  39. Carter JH, Langley JM, Kuhle S, Kirkland S (2016) Risk factors for central venous catheter-associated bloodstream infection in pediatric patients: a cohort study. Infect Control Hosp Epidemiol 37:939–945. doi:10.1017/ice.2016.83
    • View reference on publisher's website
    • View reference on PubMed
  40. Touré A, Chambrier C, Vanhems P et al (2013) Propensity score analysis confirms the independent effect of parenteral nutrition on the risk of central venous catheter-related bloodstream infection in oncological patients. Clin Nutr 32:1050–1054. doi:10.1016/j.clnu.2012.12.006
    • View reference on publisher's website
    • View reference on PubMed

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