Risk Factors for Central Venous Catheter-Related Infections in Pediatric Intensive Care

Abstract

Vilela R, Jácomo ADN, Tresoldi AT. Risk factors for central venous catheter-related infections in pediatric intensive care. Clinics. 2007;62(5):537-44. OBJECTIVES:To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection. METHOD: After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve. RESULTS: Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular) was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014) and duration of catheter use (p=0.0013), and protective factors included concomitant antibiotic use (p=0.0005) and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002). Pediatric Risk of Mortality did not discriminate the risk of infection. CONCLUSIONS: Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.

Surveillance Study of Healthcare-Associated Infections in a Pediatric Neurosurgery Unit in Italy

“…Our analysis confirmed a CVC duration ≥7 days as a risk factor for the development of a catheter-related infection and a prolonged duration of total parenteral nutrition as a risk factor for central line-associated bloodstream infections [8,9]. In particular, this survey showed that the risk of central line-associated bloodstream infections is already increased after 5 days of total parenteral nutrition administration.…”

Risk factors and preventive measures for catheter-related bloodstream infections

“…A avaliação de variáveis relacionadas à inserção e manutenção de CVC dos pacientes de uma UTI pediátrica (UTIP) identificou, através de análise de regressão logística, os seguintes fatores de risco para as infecções relacionadas ao CVC: insuficiência respiratória; duração da internação; tempo de intubação; inserção do cateter na UTI e uso de NP; inserção de mais de um cateter (p = 0,014); e tempo de permanência do cateter (p = 0,0013) 17 .…”

“…Dentre os fatores de risco para sepse na população pediátrica atendida em UTI que são diferentes daqueles encontrados em serviços direcionados para atendimento de pacientes adultos, encontra-se o local de inserção do cateter, pois não há evidência de maior risco para infecção quanto ao sítio de implante em subclávia, jugular ou femoral, como é demonstrado em pacientes adultos 12,17 . Sabe-se que crianças apresentam fragilidade da rede venosa, e a utilização do cateter central para coleta de material para exames é comum; por isso, o CVC pode ser mantido por tempo maior do que o necessário, para garantir um acesso venoso seguro.…”

Equipe interdisciplinar reduz infecção sanguínea relacionada ao cateter venoso central em Unidade de Terapia Intensiva Pediátrica

“…The incidence of Staphylococcus aureus as the etiologic agent of bloodstream infections was greater than the incidence of coagulase-negative Staphylococcus, which has been observed before in pediatric and neonatal intensive care units in South America (9,22) . Enterococcus sp was not identified as an agent of infection among this sample, despite its ascendancy in the United States.…”