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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
Original

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention.

Keywords

Peripherally inserted central catheter Central venous line Infection Paediatric intensive care unit 

Notes

Acknowledgements

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)

References

  1. 1.
    Edwards JD, Herzig CT, Liu H et al (2015) Central line–associated blood stream infections in pediatric intensive care units: longitudinal trends and compliance with bundle strategies. Am J Infect Control 43:489–493. doi: 10.1016/j.ajic.2015.01.006 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Randolph AG (2016) Pragmatic trials in critically ill children are CATCHing on. Lancet 387:1697–1698. doi: 10.1016/S0140-6736(16)00566-3 CrossRefPubMedGoogle Scholar
  3. 3.
    Nowak JE, Brilli RJ, Lake MR et al (2010) Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: business case for quality improvement. Pediatr Crit Care Med 11:579–587. doi: 10.1097/PCC.0b013e3181d90569 CrossRefPubMedGoogle Scholar
  4. 4.
    Blot SI, Depuydt P, Annemans L et al (2005) Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 41:1591–1598CrossRefPubMedGoogle Scholar
  5. 5.
    Gibson C, Connolly BL, Moineddin R et al (2013) Peripherally inserted central catheters: use at a tertiary care pediatric center. J Vasc Interv Radiol 24:1323–1331. doi: 10.1016/j.jvir.2013.04.010 CrossRefPubMedGoogle Scholar
  6. 6.
    Maki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81:1159–1171. doi: 10.4065/81.9.1159 CrossRefPubMedGoogle Scholar
  7. 7.
    Safdar N, Maki DG (2005) Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 128:489–495. doi: 10.1378/chest.128.2.489 CrossRefPubMedGoogle Scholar
  8. 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
  9. 9.
    Soares M, Bozza FA, Angus DC et al (2015) Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Med 41:2149–2160. doi: 10.1007/s00134-015-4076-7 CrossRefPubMedGoogle Scholar
  10. 10.
    Ranzani OT, Simpson ES, Augusto TB et al (2014) Evaluation of a minimal sedation protocol using ICU sedative consumption as a monitoring tool: a quality improvement multicenter project. Crit Care 18:580. doi: 10.1186/s13054-014-0580-3 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    How-to Guide: Prevent Central Line-Associated Bloodstream Infections. Cambridge, MA: Institute for Healthcare Improvement; 2012. (Available at https://www.ihi.org)
  12. 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:
  13. 13.
    Austin PC (2014) The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments: propensity scores and survival analysis. Stat Med 33:1242–1258. doi: 10.1002/sim.5984 CrossRefPubMedGoogle Scholar
  14. 14.
    Truche A-S, Darmon M, OUTCOMEREA Study Group et al (2016) Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery. Intensive Care Med 42:1408–1417. doi: 10.1007/s00134-016-4404-6 CrossRefPubMedGoogle Scholar
  15. 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
  16. 16.
    Wyss R, Ellis AR, Brookhart MA et al (2014) The role of prediction modeling in propensity score estimation: an evaluation of logistic regression, bCART, and the covariate-balancing propensity score. Am J Epidemiol 180:645–655. doi: 10.1093/aje/kwu181 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Imai K, Ratkovic M (2014) Covariate balancing propensity score. J R Stat Soc B 76:243–263. doi: 10.1111/rssb.12027 CrossRefGoogle Scholar
  18. 18.
    Brookhart MA (2006) Variable selection for propensity score models. Am J Epidemiol 163:1149–1156. doi: 10.1093/aje/kwj149 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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
  20. 20.
    Cole SR, Hernán MA (2004) Adjusted survival curves with inverse probability weights. Comput Methods Progr Biomed 75:45–49. doi: 10.1016/j.cmpb.2003.10.004 CrossRefGoogle Scholar
  21. 21.
    Parienti J-J, Mongardon N, Mégarbane B et al (2015) Intravascular complications of central venous catheterization by insertion site. N Engl J Med 373:1220–1229. doi: 10.1056/NEJMoa1500964 CrossRefPubMedGoogle Scholar
  22. 22.
    Dudeck MA, Edwards JR, Allen-Bridson K et al (2015) National healthcare safety network report, data summary for 2013, device-associated module. Am J Infect Control 43:206–221. doi: 10.1016/j.ajic.2014.11.014 CrossRefPubMedGoogle Scholar
  23. 23.
    Fontela PS, Platt RW, Rocher I et al (2012) Epidemiology of central line–associated bloodstream infections in Quebec intensive care units: a 6-year review. Am J Infect Control 40:221–226. doi: 10.1016/j.ajic.2011.04.008 CrossRefPubMedGoogle Scholar
  24. 24.
    Miller MR, Niedner MF, Huskins WC et al (2011) Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics 128:e1077–e1083. doi: 10.1542/peds.2010-3675 CrossRefPubMedGoogle Scholar
  25. 25.
    Patrick SW, Kawai AT, Kleinman K et al (2014) Health care-associated infections among critically ill children in the US, 2007–2012. Pediatrics 134:705–712CrossRefPubMedGoogle Scholar
  26. 26.
    Rosenthal VD, Al-Abdely HM, El-Kholy AA et al (2016) International nosocomial infection control consortium report, data summary of 50 countries for 2010–2015: device-associated module. Am J Infect Control 44:1495–1504. doi: 10.1016/j.ajic.2016.08.007 CrossRefPubMedGoogle Scholar
  27. 27.
    Leblebicioglu H, Erben N, Rosenthal VD et al (2014) International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003–2012. Ann Clin Microbiol Antimicrob 13:1CrossRefGoogle Scholar
  28. 28.
    Rosenthal VD (2009) Central line-associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 49:1899–1907. doi: 10.1086/648439 CrossRefPubMedGoogle Scholar
  29. 29.
    Marschall J, Mermel LA, Fakih M et al (2014) Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35:753–771. doi: 10.1086/676533 CrossRefPubMedGoogle Scholar
  30. 30.
    O’Grady NP, Alexander M, Dellinger EP et al (2002) Guidelines for the prevention of intravascular catheter-related infections. Pediatrics 110:e51. doi: 10.1542/peds.110.5.e51 CrossRefPubMedGoogle Scholar
  31. 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
  32. 32.
    Jumani K, Advani S, Reich NG et al (2013) Risk factors for peripherally inserted central venous catheter complications in children. JAMA Pediatr 167:429. doi: 10.1001/jamapediatrics.2013.775 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Gilbert RE, Mok Q, Dwan K et al (2016) Impregnated central venous catheters for prevention of bloodstream infection in children (the CATCH trial): a randomised controlled trial. Lancet 387:1732–1742CrossRefPubMedGoogle Scholar
  34. 34.
    Goes-Silva E, Abreu TF, Frota ACC et al (2009) Use of peripherally inserted central catheters to prevent catheter-associated bloodstream infection in children. Infect Control Hosp Epidemiol 30:1024–1026. doi: 10.1086/606040 CrossRefPubMedGoogle Scholar
  35. 35.
    Al Raiy B, Fakih MG, Bryan-Nomides N et al (2010) Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. Am J Infect Control 38:149–153. doi: 10.1016/j.ajic.2009.06.008 CrossRefPubMedGoogle Scholar
  36. 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
  37. 37.
    Safdar N, Maki DG (2004) The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 30:62–67. doi: 10.1007/s00134-003-2045-z CrossRefPubMedGoogle Scholar
  38. 38.
    Chopra V, Ratz D, Kuhn L et al (2014) PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 127:319–328. doi: 10.1016/j.amjmed.2014.01.001 CrossRefPubMedGoogle Scholar
  39. 39.
    Carter JH, Langley JM, Kuhle S, Kirkland S (2016) Risk factors for central venous catheter-associated bloodstream infection in pediatric patients: a cohort study. Infect Control Hosp Epidemiol 37:939–945. doi: 10.1017/ice.2016.83 CrossRefPubMedGoogle Scholar
  40. 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

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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