Intensive Care Medicine

, Volume 43, Issue 8, pp 1097–1104 | Cite as

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

  • Ricardo Silveira YamaguchiEmail author
  • Danilo Teixeira Noritomi
  • Natalia Viu Degaspare
  • Gabriela Ortega Cisternas Muñoz
  • Ana Paula Matos Porto
  • Silvia Figueiredo Costa
  • Otavio T. Ranzani



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.


Peripherally 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.

Supplementary material

134_2017_4852_MOESM1_ESM.pdf (391 kb)
Supplementary material 1 (PDF 391 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Ricardo Silveira Yamaguchi
    • 1
    • 2
    • 3
    Email author
  • Danilo Teixeira Noritomi
    • 1
  • Natalia Viu Degaspare
    • 1
    • 2
    • 3
  • Gabriela Ortega Cisternas Muñoz
    • 1
    • 2
    • 3
  • Ana Paula Matos Porto
    • 1
  • Silvia Figueiredo Costa
    • 4
  • Otavio T. Ranzani
    • 1
    • 5
    • 6
  1. 1.Americas Medical ServiceAmericas Research and Education InstituteSão PauloBrazil
  2. 2.Pediatric Intensive Care UnitHospital da Luz Vila MarianaSão PauloBrazil
  3. 3.Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das ClínicasUniversity of São PauloSão PauloBrazil
  4. 4.Laboratory of Bacteriology (LIM 54), Department of Infectious Diseases, Medical SchoolUniversity of São PauloSão PauloBrazil
  5. 5.Pulmonary Division, Heart Institute, Hospital das ClínicasUniversity of São PauloSão PauloBrazil
  6. 6.Department of PulmonologyHospital Clinic of Barcelona, IDIBAPS, CIBERESBarcelonaSpain

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