Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

Dubbink-Verheij, Gerdina H.; Bekker, Vincent; Pelsma, Iris C. M.; Zwet, Erik W. van; Smits-Wintjens, Vivianne E.H.J.; Steggerda, Sylke J.; Pas, Arjan B. te; Lopriore, Enrico

doi:10.3389/fped.2017.00142

Cited by 33 publications

(31 citation statements)

References 31 publications

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“…24 Nevertheless, lower rates are present in Europe ranging from 10.6 to 12.3 and United States ranging from 1.8 to 5.2. 24,25 Regarding the causative organisms in this study, gram positive bacteria represented more than half of the causative agents; MRSA 35% and CONS 29% were the most prevalent organisms, this compares to other studies which found CONS 51% and S. aureus 23%. 25 An important fact to note was that DAI rates in the study did not affect patient outcome in terms of mortality; we showed no correlation between patient outcome and CLABSI and VAP rates.…”

Section: Discussioncontrasting

confidence: 68%

“…24,25 Regarding the causative organisms in this study, gram positive bacteria represented more than half of the causative agents; MRSA 35% and CONS 29% were the most prevalent organisms, this compares to other studies which found CONS 51% and S. aureus 23%. 25 An important fact to note was that DAI rates in the study did not affect patient outcome in terms of mortality; we showed no correlation between patient outcome and CLABSI and VAP rates. The reason for that may be attributed to early diagnosis and strict adherence to medical protocol of treatment and care of nosocomial infection that may have averted an unfavorable outcome.…”

Section: Discussioncontrasting

confidence: 68%

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Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Mohamed

Abdelfattah

et al. 2020

Int J Contemp Pediatr

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Background: Device Associated Infection (DAI) namely Ventilator Associated Pneumonia (VAP) and Central Line Associated Blood Stream Infection (CLABSI) is one of the challenges for both neonatal nurses and doctors. Aims of the study were 1) Assess the rate of DAI occurrence among neonates, 2) explore the relationship between DAI rates and certain risk factors such as nurse patient ratio, hand hygiene practice, gestational age (GA), weight, and length of hospital stay among neonates.Methods: Descriptive correlational survey research design. Sample: All neonates admitted in twelve months-duration were included (total number 1090 neonates). Nurses and doctors were observed for compliance to adequate hand hygiene technique. Tools: 1) Center for Disease Control (CDC) criteria to calculate DAI rates, 2) Hand hygiene five points checklist 3) Review of neonates charts to collect data as weight, GA 4) Ballard score and 5) nurse/patient ratio.Results: 24 neonates developed DAI, high significant negative correlations between DAI and infants’ weight, GA, nurse/patient ratio and overall compliance to hand hygiene techniques were reported (p-value ≤0.05). Length of hospital stay, inadequate hand hygiene technique had strong positive correlations with DAI rate (p-value ≤0.05).Conclusions: Factors that could affect DAI were infant’s weight, GA, length of hospital stay, inadequate hand hygiene technique and nurse/patient ratio. Recommendations: implementation of infection control programs to raise nurses as well as physicians’ compliance to adequate hand hygiene technique and increase number of nurses in the Neonatal Intensive Care Unit (NICU) per shift.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussioncontrasting

confidence: 68%

Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Mohamed

Abdelfattah

et al. 2020

Int J Contemp Pediatr

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“…Unlike in the adult ICU, implementations of care bundles in pediatric and neonatal intensive care units have had inconsistent outcomes in reducing CLABSIs (Wirtschafter et al, 2010). Additionally, studies in neonates have failed to demonstrate a significant difference in CLABSI risk between catheter types used mostly in the NICU (peripherally inserted, umbilical and femoral) (Dubbink-Verheij et al, 2017). Studies have also shown that it is possible to reduce neonatal CLABSI rates with hospital-based interventions (Bizzarro et al, 2010;Pronovost, 2008).…”

Section: Clabsis In Pediatricsmentioning

confidence: 99%

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Lutwick

Al-Maani

Mehtar

et al. 2019

International Journal of Infectious Diseases

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“…An estimated 21% of babies admitted born at ≥ 34 weeks of gestation and admitted to a NNU receive a CVC, but this proportion rises to 70% for babies born before 32 weeks of gestational age [based on unpublished analysis of the National Neonatal Research Database (NNRD) (Katie Harron, University College London, 2014, personal communication)]. 21 Peripherally inserted central venous catheters (PICCs) are frequently used in NNUs. The PICC is a very narrow tube placed through the skin and into a central vein, using a needle, which is then removed.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial-impregnated central venous catheters for preventing neonatal bloodstream infection: the PREVAIL RCT

Gilbert

Brown

Faria

et al. 2020

Health Technol Assess

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Background Clinical trials show that antimicrobial-impregnated central venous catheters reduce catheter-related bloodstream infection in adults and children receiving intensive care, but there is insufficient evidence for use in newborn babies. Objectives The objectives were (1) to determine clinical effectiveness by conducting a randomised controlled trial comparing antimicrobial-impregnated peripherally inserted central venous catheters with standard peripherally inserted central venous catheters for reducing bloodstream or cerebrospinal fluid infections (referred to as bloodstream infections); (2) to conduct an economic evaluation of the costs, cost-effectiveness and value of conducting additional research; and (3) to conduct a generalisability analysis of trial findings to neonatal care in the NHS. Design Three separate studies were undertaken, each addressing one of the three objectives. (1) This was a multicentre, open-label, pragmatic randomised controlled trial; (2) an analysis was undertaken of hospital care costs, lifetime cost-effectiveness and value of information from an NHS perspective; and (3) this was a retrospective cohort study of bloodstream infection rates in neonatal units in England. Setting The randomised controlled trial was conducted in 18 neonatal intensive care units in England. Participants Participants were babies who required a peripherally inserted central venous catheter (of 1 French gauge in size). Interventions The interventions were an antimicrobial-impregnated peripherally inserted central venous catheter (coated with rifampicin–miconazole) or a standard peripherally inserted central venous catheter, allocated randomly (1 : 1) using web randomisation. Main outcome measure Study 1 – time to first bloodstream infection, sampled between 24 hours after randomisation and 48 hours after peripherally inserted central venous catheter removal. Study 2 – cost-effectiveness of the antimicrobial-impregnated peripherally inserted central venous catheter compared with the standard peripherally inserted central venous catheters. Study 3 – risk-adjusted bloodstream rates in the trial compared with those in neonatal units in England. For study 3, the data used were as follows: (1) case report forms and linked death registrations; (2) case report forms and linked death registrations linked to administrative health records with 6-month follow-up; and (3) neonatal health records linked to infection surveillance data. Results Study 1, clinical effectiveness – 861 babies were randomised (antimicrobial-impregnated peripherally inserted central venous catheter, n = 430; standard peripherally inserted central venous catheter, n = 431). Bloodstream infections occurred in 46 babies (10.7%) randomised to antimicrobial-impregnated peripherally inserted central venous catheters and in 44 (10.2%) babies randomised to standard peripherally inserted central venous catheters. No difference in time to bloodstream infection was detected (hazard ratio 1.11, 95% confidence interval 0.73 to 1.67; p = 0.63). Secondary outcomes of rifampicin resistance in positive blood/cerebrospinal fluid cultures, mortality, clinical outcomes at neonatal unit discharge and time to peripherally inserted central venous catheter removal were similar in both groups. Rifampicin resistance in positive peripherally inserted central venous catheter tip cultures was higher in the antimicrobial-impregnated peripherally inserted central venous catheter group (relative risk 3.51, 95% confidence interval 1.16 to 10.57; p = 0.02) than in the standard peripherally inserted central venous catheter group. Adverse events were similar in both groups. Study 2, economic evaluation – the mean cost of babies’ hospital care was £83,473. Antimicrobial-impregnated peripherally inserted central venous catheters were not cost-effective. Given the increased price, compared with standard peripherally inserted central venous catheters, the minimum reduction in risk of bloodstream infection for antimicrobial-impregnated peripherally inserted central venous catheters to be cost-effective was 3% and 15% for babies born at 23–27 and 28–32 weeks’ gestation, respectively. Study 3, generalisability analysis – risk-adjusted bloodstream infection rates per 1000 peripherally inserted central venous catheter days were similar among babies in the trial and in all neonatal units. Of all bloodstream infections in babies receiving intensive or high-dependency care in neonatal units, 46% occurred during peripherally inserted central venous catheter days. Limitations The trial was open label as antimicrobial-impregnated and standard peripherally inserted central venous catheters are different colours. There was insufficient power to determine differences in rifampicin resistance. Conclusions No evidence of benefit or harm was found of peripherally inserted central venous catheters impregnated with rifampicin–miconazole during neonatal care. Interventions with small effects on bloodstream infections could be cost-effective over a child’s life course. Findings were generalisable to neonatal units in England. Future research should focus on other types of antimicrobial impregnation of peripherally inserted central venous catheters and alternative approaches for preventing bloodstream infections in neonatal care. Trial registration Current Controlled Trials ISRCTN81931394. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 57. See the NIHR Journals Library website for further project information.

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Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

Cited by 33 publications

References 31 publications

Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Antimicrobial-impregnated central venous catheters for preventing neonatal bloodstream infection: the PREVAIL RCT

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