Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units

Chien, Li Yin; MacNab, Ying C.; Aziz, Khalid; Andrews, Wayne; McMillan, Douglas; Lee, Shoo K.

doi:10.1097/00006454-200206000-00006

Cited by 128 publications

(109 citation statements)

References 24 publications

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“…The central venous (Silastic) catheters were inserted by a member of medical staff under an aseptic technique. One unit of heparin Potentially relevant RCTs identified and screened for retrieval (n=35) RCTs excluded without indwelling catheters or central venous line Studies were excluded because did not use an antibiotic and used other lock or flush solution (19) and included adult population (1) RCTs retrieved for more detailed evaluation (n=23)…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Central venous lines (CVLs) are routinely used for monitoring and the administration of total parenteral nutrition (TPN) and medications in neonatal intensive care units (NICUs) 1 A prospective cohort study on 19 000 infants admitted to NICUs, CVLs were placed in 22.5% of patients and were associated with a significant risk of systemic bacterial infection. 1 One study showed the rate of CVL-associated bacteremia to be 13 per 1000 percutaneous catheter days compared to 3 per 1000 days in infants without a CVL.…”

Section: Introductionmentioning

confidence: 99%

“…1 One study showed the rate of CVL-associated bacteremia to be 13 per 1000 percutaneous catheter days compared to 3 per 1000 days in infants without a CVL. 1 Bloodstream infections caused by normal skin flora result in catheter colonization, bacteremia and prolonged hospitalization. [2][3][4][5][6] Coagulase-negative-staphylococcal (CoNS) bacteremia accounts for 80% of all CVL-related bacteremia.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6] Coagulase-negative-staphylococcal (CoNS) bacteremia accounts for 80% of all CVL-related bacteremia. 1,7,8 Other organisms associated with central catheters are Klebsiella, Enterobacter, Escherichia coli, Serratia, Citrobacter and Candida species. 1,7,8 Neonatal sepsis remains an important cause of morbidity and mortality in NICUs despite advances in care and the use of broad spectrum antibiotics.…”

Section: Introductionmentioning

confidence: 99%

“…1,7,8 Other organisms associated with central catheters are Klebsiella, Enterobacter, Escherichia coli, Serratia, Citrobacter and Candida species. 1,7,8 Neonatal sepsis remains an important cause of morbidity and mortality in NICUs despite advances in care and the use of broad spectrum antibiotics. [9][10][11][12][13][14][15] Factors that have been reported to increase the incidence of catheter-related bloodstream infection (CRBSI) include low birth weight, prematurity, number of CVL days, the number of previously placed catheters and infusion of TPN.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic antibiotics in the prevention of catheter-associated bloodstream bacterial infection in preterm neonates: a systematic review

et al. 2008

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Objective: To evaluate the efficacy of prophylactic antibiotics in preventing infection associated with central venous catheters in preterm neonates.Study Design: The search strategy of the Cochrane Neonatal Review Group was used. The following databases were searched: Medline, Cochrane Central Register of Controlled Trials, CINAHL and EMBASE. In addition, we hand-searched abstracts of Pediatric Academic Societies annual meetings published in Pediatric Research (1990 to July 2007 and Canadian Pediatric Society annual meeting proceedings (1990( to July 2007. No language restrictions were applied. Included were randomized controlled trials of antibiotics given prophylactically to prevent infection in preterm infants (<37 completed weeks) less than 1-month old admitted to neonatal intensive care units. Both centrally or peripherally inserted central venous catheters were included. Assessment of methodological quality and extraction of data for included trials was undertaken independently by two authors. When suitable, data from trials were combined in a meta-analysis.Result: A total of three studies were found which addressed the role of prophylactic antibiotics to prevent catheter-related infection in neonates. Two studies used vancomycin as the prophylactic antibiotic and one study used amoxicillin. The meta-analysis of studies that used vancomycin had shown an absolute risk reduction of infection from 23 to 2.4%, which yields a number needed to treat equal to 5 (P ¼ 0.0001). Total duration of catheter stay and mortality, were both similar in the vancomycin and control groups. In the amoxicillin study, catheter-related sepsis was not significantly different between the treatment and control groups (P ¼ 0.40). The rate of colonization, however, was significantly higher in the control group (relative risk 0.48; 95% CI 0.12, 1.35). The incidence of necrotizing enterocolitis, intracranial hemorrhage, thrombosis and deaths were not statistically significant between groups.Conclusion: Prophylactic vancomycin appeared to be effective in preventing catheter-related sepsis in preterm neonates. The potential risks, however, of the emergence of resistance because of prophylactic antibiotics, and their continued effectiveness, need further evaluation, before routine use can be recommended.

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Section: Description Of Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%