Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis
- 2k Downloads
Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children.
We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil. We included patients aged 0–14 years, who needed a CVC or PICC during a PICU stay from January 2013 to December 2015. Our primary endpoint was CLABSI up to 30 days after catheter placement. We defined CLABSI based on the Center for Disease Control and Prevention’s National Healthcare Safety Networks (NHSN) 2015 surveillance definitions. To account for potential confounders, we used propensity scores with inverse probability weighting.
A total of 1660 devices (922 PICCs and 738 CVCs) in 1255 children were included. The overall CLABSI incidence was 2.28 (95% CI 1.70–3.07)/1000 catheter-days. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR 2.20, 95% CI 1.05–4.61; p = 0.037) compared with PICCs. In a sensitivity analysis, CVCs remained associated with higher risk of CLABSI (adjHR 2.18, 95% CI 1.02–4.64; p = 0.044) after adding place of insertion and use of parenteral nutrition to the model as a time-dependent variable.
PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention.
KeywordsPeripherally inserted central catheter Central venous line Infection Paediatric intensive care unit
We thank all the staff working at the participating ICUs. We also thank the Americas Research and Education Institute, São Paulo, Brazil. This research was supported by funding from the Americas Research and Education Institute, São Paulo, Brazil. The sponsor had no role in the acquisition, analysis or interpretation of the data.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
- 8.Chopra V, O’Horo JC, Rogers MAM et al (2013) The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 34:908–918. doi: 10.1086/671737 CrossRefPubMedGoogle Scholar
- 11.How-to Guide: Prevent Central Line-Associated Bloodstream Infections. Cambridge, MA: Institute for Healthcare Improvement; 2012. (Available at https://www.ihi.org)
- 12.Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and non-central line-associated Bloodstream Infection)—Device associated module. Updated January 2017. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf:
- 15.Pages J, Hazera P, 3SITES Study Group et al (2016) Comparison of alcoholic chlorhexidine and povidone–iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study. Intensive Care Med 42:1418–1426. doi: 10.1007/s00134-016-4406-4 CrossRefPubMedGoogle Scholar
- 19.Arpino B, Cannas M (2016) Propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the Apgar score: propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the Apgar score. Stat Med 35:2074–2091. doi: 10.1002/sim.6880 CrossRefPubMedGoogle Scholar
- 31.Advani S, Reich NG, Sengupta A et al (2011) Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis 52:1108–1115. doi: 10.1093/cid/cir145 CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Hord JD, Lawlor J, Werner E et al (2016) Central line associated blood stream infections in pediatric hematology/oncology patients with different types of central lines: cLABSI in patients with different central line types. Pediatr Blood Cancer 63:1603–1607. doi: 10.1002/pbc.26053 CrossRefPubMedGoogle Scholar
- 40.Touré A, Chambrier C, Vanhems P et al (2013) Propensity score analysis confirms the independent effect of parenteral nutrition on the risk of central venous catheter-related bloodstream infection in oncological patients. Clin Nutr 32:1050–1054. doi: 10.1016/j.clnu.2012.12.006 CrossRefPubMedGoogle Scholar