Abstract
Objective
Analysis of infectious complications and risk factors in percutaneous central venous catheters.
Design
One-year observational, prospective, multicenter study (1998–1999).
Setting
Twenty Spanish pediatric intensive care units.
Patients
Eight hundred thirty-two children aged 0–14 years.
Intervention
None.
Measurements and main results
One thousand ninety-two catheters were analyzed. Seventy-four (6.81%) catheter-related bloodstream infections (CRBSI) were found. The CRBSI rate was 6.4 per 1,000 CVC days (95% CI 5.0–8.0). Risk factors for CRBSI were weight under 8 kg (p < 0.001), cardiac failure (RR 2.69; 95% CI 1.95–4.38; p < 0.001), cancer (RR 1.66; 95% CI 0.97–2.78; p = 0.05), silicone catheters (RR 2.82; 95% CI 1.49–5.35; p = 0.006), guidewire exchange catheterization (p = 0.002), obstructed catheters (RR 2.67; 95% CI 1.63–4.39; p < 0.001), and more than 12 days' indwelling time (RR 5.9; 95% CI 3.63–9.41; p < 0.001). Multivariate Cox regression identified lower patient weight (HR 2.4; 95% CI 1.11–5.19; p = 0.002), guidewire exchange catheterization (HR 2.2; 95% CI 1.07–4.54; p = 0.049) and more than 12 days' indwelling time (HR 1.97; 95% CI 0.89–4.36; p = 0.089) as significant independent predictors of CRBSI. Factors which protected against infection were the use of povidone–iodine on hubs (HR 0.42; 95% CI 0.19–0.96; p = 0.025) and porous versus impermeable dressing (HR 0.41; 95% CI 0.23–0.74; p = 0.004). Two children (0.24%) died from endocarditis following catheter-related sepsis due to Stenotrophomonas maltophilia in one case and P. aeruginosa in the other.
Conclusions
Catheter-related sepsis is associated with lower patient weight and more than 12 days' indwelling time, but not with the insertion site. Cleaning hubs with povidone–iodine protects from infection.
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The named authors wrote this article on behalf of the Spanish Central Venous Catheter Pediatric Study Group, the members of which are listed in the Appendix.
Appendix
Appendix
The Spanish Central Venous Catheter Pediatric Study Group is composed of M. Angeles García-Teresa, MD and Juan Casado-Flores, MD, PhD, Hospital Infantil Niño Jesús, Madrid; M. Angel Delgado, MD Hospital Infantil La Paz, Madrid; Jorge Roqueta-Mas, MD, PICU, Hospital Vall de Hebrón, Barcelona; Francisco Cambra-Lasaosa, MD, PICU, Hospital Clinic S Joan de Deu, Barcelona; Andrés Concha-Torre, MD PICU, Hospital Central de Asturias, Oviedo; J. Ignacio Sánchez, MD, PICU, Hospital Infantil 12 de Octubre, Madrid; J. Carlos de Carlos-Vicente, MD PICU, Hospital Son Dureta, Palma de Mallorca; Isabel Martos-Sánchez, MD, PICU, Hospital Ramón y Cajal, Madrid; Antonio Rodríguez-Núñez, MD, Hospital Xeral de Galicia, Santiago de Compostela; Julio Melendo-Jimeno, MD, PICU, Hospital Miguel Server, Zaragoza; Alvaro Castellanos Ortega, MD, PICU, Hospital Universitario Marqués de Valdecilla, Santander; Javier Pilar, MD, PICU, Hospital de Cruces, Baracaldo (Vizcaya); Enrique Quiroga-Ordóñez, MD, PICU, Hospital Materno Infantil Teresa Herrera, La Coruña; J. Antonio Soult-Rubio, MD, PICU, Hospital Universitario Virgen del Rocío, Sevilla; Luis Sancho-Pérez, MD, PICU, Hospital Infantil Gregorio Marañón, Madrid; Eduardo Pérez Yarza, MD, PICU, Hospital Ntra Sra de Aranzazu, San Sebastián; J. Espinosa Ruiz-Cabal, MD, Hospital Universitario Infanta Cristina, Badajoz; Elisa Lozano- Arrans, MD Hospital Clínico San Cecilio, Granada; J. Ramón Fernández-Prieto, MD, PICU, Hospital Arquitecto Marcide, Ferrol (La Coruña); Ignacio Ibarra de la Rosa, MD, PICU, Hospital Reina Sofía, Córdoba.
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García-Teresa, M.Á., Casado-Flores, J., Delgado Domínguez, M.Á. et al. Infectious complications of percutaneous central venous catheterization in pediatric patients. Intensive Care Med 33, 466–476 (2007). https://doi.org/10.1007/s00134-006-0508-8
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DOI: https://doi.org/10.1007/s00134-006-0508-8