Prolonged catheter dwell time, pediatric ICU exposure, and administration of parenteral nutrition as the indication for PICC insertion are important predictors of PICC-associated CLABSI in hospitalized children. A careful assessment of these risk factors may be important for future success in preventing CLABSIs in hospitalized children with PICCs.

Objective To determine whether the risk of central line-associated bloodstream infections (CLA-BSI) remained constant over the duration of peripherally inserted central venous catheters (PICC) in high risk neonates. Patient and Methods We performed a retrospective cohort study of NICU patients who had a PICC inserted between January 1, 2006 and December 31, 2008. A Poisson regression model with linear spline terms to model time since PICC insertion was used to evaluate potential changes in the risk of CLA-BSI while adjusting for other variables. Results 683 neonates were eligible for analysis. There were 21 CLA-BSIs within a follow-up time of 10,470 catheter days. The incidence of PICC-associated CLA-BSI was 2.01 per thousand catheter days (95% CI=1.24, 3.06). The incidence rate of CLA-BSI increased by 14% per day during the first 18 days following PICC insertion (incidence rate ratio [IRR] 1.14; CI 1.04, 1.25). From days 19 through 35 after PICC insertion, the trend reversed (IRR 0.8; 95% CI 0.66, 0.96). From days 36 through 60 after PICC insertion, the incidence rate of CLA-BSI once again increased by 33% per day (IRR 1.33; 95% CI 1.12, 1.57). There was no statistically significant association between gestational age groups, birth weight groups, and chronological age groups with the risk of CLA-BSI. Conclusion Our data suggest that catheter duration is an important risk factor for PICC associated CLA-BSI in the NICU. A significant daily increase in the risk of CLA-BSI after 35 days may warrant PICC replacement if intravascular access is necessary beyond that period.

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