Outcomes associated with early removal versus retention of peripherally inserted central catheters after diagnosis of catheter-associated infections in neonates

Deshpande, Poorva; Jain, Amish; Shah, Prakesh S.

doi:10.3109/14767058.2016.1157578

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Deshpande et al [45] found a catheter clearance rate for retained catheters during CLABSI caused by CoNS higher than the one described in our study (39% vs 25%): this work also considered all different CoNS together, therefore this difference might be explained by the same considerations exposed above.…”

Section: Discussioncontrasting

confidence: 50%

Staphylococcus capitis Central-Line Associated Bloodstream Infections (CLABSI) in the NICU: A Single-Center 4-Year Experience on Central Line Management during Sepsis Treatment

Sala,

Pivetti,

Vittorini

et al. 2024

Preprint

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Coagulase negative Staphylococci (CoNS) are reported to be responsible for 50-60% of bloodstream infections in very preterm (&lt;1500 g) infants in Neonatal Intensive Care Units (NICU). Staphylococcus capitis is an increasingly prevalent pathogen in neonatal setting, frequently causing central-line associated bloodstream infections (CLABSI) that can be difficult to eradicate. CVC removal versus in situ treatment of CoNS CLABSIs is a matter of debate, with no clear consensus emerging in the existing literature. We revised all S. capitis CLABSIs in our NICU between 2019 and 2022, focusing on the role of catheter removal for eradication. Among 25 cases, 17 CVCs were removed after diagnosis, leading to a 76.5% eradication rate in this group. 3 infants had a persistently positive blood culture after CVC substitution. A new catheter was than inserted after a 48-hours washout period, resulting in resolution of the infection. Only 2 of 8 patients (25%) who retained the catheter after diagnosis, underwent infection eradication with antibiotic therapy alone. Catheter removal, when feasible, seems to be the most effective strategy to eradicate S. capitis CLABSIs, sometimes even requiring a 48-hours washout period before reinsertion. Further studies on this subject are needed to better standardize the management of this kind of infections.

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Section: Discussioncontrasting

confidence: 50%

Staphylococcus capitis Central-Line Associated Bloodstream Infections (CLABSI) in the NICU: A Single-Center 4-Year Experience on Central Line Management during Sepsis Treatment

Sala,

Pivetti,

Vittorini

et al. 2024

Preprint

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“…Despite the many possible risk factors for death that were found in the bivariate analysis (underlying renal disease, origin of infection, ICU admission at onset of CRBSI, surgery at present admission, duration of antibiotic after catheter removal, and type of catheter), no significant risk factor was found in the multivariate analysis. Compared with previously reported risk factors for death, which were catheter retention [19], surgery in the present admission, infection caused by P. aeruginosa, complicated bacteremia (recurrence, septic arthritis, wound infection) [13], male patients, and catheterizations with triple lumen type catheters [20], our study found that surgery at present admission and type of catheter (short-term central venous catheter or arterial catheter and tunneled hemodialysis catheter) were also possible risks but were not found to be significant in the multivariate analysis. Catheter retention and male patients were not found to be significant risk factors in this study.…”

Section: Discussionmentioning

confidence: 74%

Microbial epidemiology and risk factors for relapse in gram-negative bacteria catheter-related bloodstream infection with a pilot prospective study in patients with catheter removal receiving short-duration of antibiotic therapy

et al. 2020

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Background: Infectious Diseases Society of America (IDSA) guidelines suggest 7-14 days' duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI). The objectives of this study were to review microbial epidemiology, to determine rate and risk factors for relapse, and to compare clinical outcomes in patients receiving long-versus short-duration antibiotic therapy. Methods: A retrospective phase 1 study was conducted between January 2010 and October 2016 to review microbial epidemiology and to determine the incidence of and risk factors for relapse in patients with GNB CRBSI, according to the IDSA guidelines diagnostic criteria. In phase 2 of the study, patients without risk factors for relapse between November 2016 and October 2017 were prospectively recruited to receive antibiotic therapy for 7 days after catheter removal. Matched patients from the retrospective phase 1 study who had received antibiotic therapy for ≥14 days were selected as a phase 2 control group to compare outcomes. Results: In phase 1, three most common pathogens identified among 174 cases were Pseudomonas aeruginosa (22.0%), Klebsiella pneumoniae (16.7%), and Stenotrophomonas maltophilia (13.4%). Eighty-nine episodes of infection occurred while patients were receiving antibiotic therapy. Of 140 cases, the relapse rate was 6.4%. Catheter retention was the only risk factor strongly associated with relapse (odds ratio = 145.32; 95% confidence interval 12.66-1667.37, P < 0.001). In phase 2, 11 patients with catheter removal were prospectively recruited to receive short-duration therapy. The number of patients with relapse receiving long-or short-duration therapy was 1 (3%) and 0 (0%), respectively (P = 1.000).

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“…A infecção de corrente sanguínea envolve potenciais fatores de risco como: peso; idade gestacional; tempo de permanência do cateter; diagnóstico clínico; tipos de cateteres e terapia intravenosa (29) . Cuidados para evitar o surgimento de focos infecciosos são essenciais para evitar a retirada precoce e perda do cateter, bem como o comprometimento do tratamento, o que pode ocasionar várias complicações no neonato (34) .…”

Section: Resultsunclassified

Cuidados e limitações no manejo do cateter central de inserção periférica em neonatalogia

Lui

Zilly

França

et al. 2018

R. Enferm. Cent. O. Min.

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Objetivo: Identificar evidências científicas que investiguem os cuidados e limitações no manejo do Cateter Central de Inserção Periférica em neonatologia. Método: Revisão integrativa da literatura, realizada na Biblioteca Virtual, em Saúde, considerando as publicações disponíveis no período 2007 a 2016, que retratassem a experiência brasileira. Foram selecionadas 24 publicações. Resultados: Dentre os cuidados para inserção do cateter, o conhecimento teórico-prático foi o de maior relevância, seguido por contenção da dor; orientação e consentimento familiar; escolha do sítio de inserção e mensuração do cateter; uso de barreira máxima e preparo do membro. Os cuidados para manutenção incluíram: educação permanente da equipe; técnicas assépticas para manuseio e realização de curativo; higienização das mãos e lavagem do cateter com solução salina 0,9%. As limitações que se destacaram: infecção, flebite bacteriana; obstrução; ruptura; perda acidental; extravasamento; não progressão; dificuldade de acesso vascular; posicionamento da ponta do cateter; tipo de cateter, flebite química ou mecânica. Conclusão: Aprimorar as ações de enfermagem por meio da educação permanente contribui para que a assistência torne-se efetiva, contínua e proativa. Ressalta-se também a necessidade de estudos com melhores níveis de evidência científica em relação ao manejo do Cateter Central de Inserção Periférica em neonatologia.

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Outcomes associated with early removal versus retention of peripherally inserted central catheters after diagnosis of catheter-associated infections in neonates

Abstract: Retaining peripherally inserted central catheters after diagnosis of central line-associated bloodstream infection was associated with longer duration of bacteremia and prolonged exposure to systemic antibiotics as well as increased mortality in Gram-negative bacteremia.

Cited by 9 publications

References 15 publications

Staphylococcus capitis Central-Line Associated Bloodstream Infections (CLABSI) in the NICU: A Single-Center 4-Year Experience on Central Line Management during Sepsis Treatment

Staphylococcus capitis Central-Line Associated Bloodstream Infections (CLABSI) in the NICU: A Single-Center 4-Year Experience on Central Line Management during Sepsis Treatment

Microbial epidemiology and risk factors for relapse in gram-negative bacteria catheter-related bloodstream infection with a pilot prospective study in patients with catheter removal receiving short-duration of antibiotic therapy

Cuidados e limitações no manejo do cateter central de inserção periférica em neonatalogia

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