Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study

Abstract

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.

Keywords: NICU; catheter-related infections; central venous catheters; infection; peripheral venous catheterization.

Figures

FIGURE 1

Distribution of PICC dwell time. PICCs were grouped into 5-day time bins based on their dwell time. PICCS with dwell times of >90 days (n = 35) are not shown.

FIGURE 2

Incidence of CLABSIs during 10-day time intervals after PICC insertion for Gram-positive bacteria, Gram-negative bacteria, and Candida spp.

FIGURE 3

Predicted CLABSI rate (solid line) with 95% CIs (shading) over catheter dwell time for a given hospital, age, birth weight, CLABSI from previous PICC, and concurrent PICC. For a neonate with different characteristics, the predicted risk of CLABSIs could be higher or lower, but the shape of the line would remain the same.