Abstract
Catheter-related sepsis is commonly encountered in the neonatal intensive care unit. We retrospectively studied infants with vascular catheters at 2 NICUs. Data were obtained from the computerised admission records available at both the hospitals. Our aims were to describe the clinical and microbial profile of nosocomial sepsis in infants with vascular catheters [umbilical artery (UA), umbilical venous (UV), central venous Broviac (CV), percutaneously placed central venous (PC), peripheral artery (PA)], and to determine the association between catheter type, duration and sepsis in a subset of the population. Nosocomial sepsis (positive blood culture after the 3rd postnatal day) occurred in 217 of 2091 (10.4%) infants. Infected infants, in contrast to non-infected, had a significantly (P < 0.001) greater number of multiple catheters (2.3 vs 1.4) had lower birth weights (1.2 vs 2.1 kg), were younger (28 vs 33 weeks) and had lower 1 and 5 minute Apgar scores (4.3 and 6.7 vs 5.5 and 7.4). The most common organism was coagulase negativeStaphylococcus. In a subset population as analyses revealed, longer duration of UA use was associated with higher infection rates [13.6% with UA use for ≥ 8 days vs 1.3% for ≤ 7 days ( P < 0.0001)]. PC use had a lower rate of sepsis than CV use (5.1% vs 15.2%; P < 0.05). Use of intravascular catheters should be balanced between the need for vascular access and the risk of sepsis.
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Warner BW, Gorgone P, Schilling S, Farrekk M, Ghory MJ, Multile purpose central venous access in infants less than 1000 grms.J Pediatr Surg 1987; 22: 820–822.
Sadiqu HF, Devaskar S, Keenan WJ, Weber TR. Broviac catheterization in low birth weight infants: incidence and treatment of associated complications.Crit Care Med 1987; 15 : 47–50.
King DR, Komer M, Hoffman Jet al. Broviac catheter sepsis: the natural history of an iatrogenic infection.J Pediatr Surg 1985; 20 : 728–33.
Hansell DT, Park R, Jensen R, Davidson L, Henderson G, Gray GR. Clinical significance and etiology of infected catheters used for total parenteral nutrition.Surg Gynecol Obstet 1986; 163: 469–474.
Landers S, Moise AA, Fraley K, Smith O, Baker CJ. Factors associated with umbilical catheter-related sepsis.AJDC 1991; 145: 675–680.
Krauss AN, Caliendo TJ, Kannan MM. Bacteremia in newborn infants following umbilical catheterization.N Y State J Med 1972; 72: 1136–1137.
Bard H, Albert G, Teasdale F, Doray B, Martineau B. Prophylactic antibiotics in chronic umbilical artery cateterization in respiratory distress syndrome.Arch Dis Child 1973; 48: 630–635.
Hall RT, Rhodes PG. Total parenteral alimentation via indwelling umbilical catheters in the newborn period.Arch Dis Child 1976; 51: 929–934.
Balagtas RC, Bell CE, Edwards LD, Levin S. Risk of local and systemic infections associated with umbilical vein catheterixation: a prospective study in 86 newborn patient.Pediatrics 1971; 48 : 359–367.
Schiff DE, Stonestreet BS. Central venous catheters in low birth infants: incidence of related complications.J Perinatol 1993; 13 : 153–158.
Salzman MB, Isenberg HD, Shapiro JF, Lipsitz PJ, Rubin LG. A prospective study of the catheter hub as the portal of entry for the microorganisms causing cathetr-related sepsis in neonates.J Infect Dis 1993; 167: 487–490.
Hogan L, Pulito AR. Broviac central venous catheters inserted via the saphenous or femoral vein in the NICU under local anetheis.J Pediatr Surg 1993; 27: 1185–1188.
Grisoni ER, Methat SK, Connors AR Thrombosis and infection complicating central venous catheterization in neonates.J Pediatr Surg 1986; 21: 772–776.
Lally KP, Hardin WD, Boettcher Met al. Broviac catheter insertion: operating room or neonatal intensive care unit.J Pediatr Surg 1987; 22 : 823–824.
Robertys JP, Gollow IJ. Central venous cateters in surgical nenonates.J Pediatr Surg 1990; 25: 632–634.
Krishnakutty R, Butcher C, Daugherty D, Marucco L, Meadow W. Uncommon but serious side-effects of hazardous but indicated procedures: what if they’re not so uncommon ? A study of catheter-associated bactermia in the NICU.Fed Res 1994; 35 : 299A (Abstract no. 1780).
Klein JO, Marcy M. Bacterial sepsis and meningitis. In : Remington JS, Klein JO (eds.)Infectious disease of the fetus and new-born infant WB Saunders Co., 1995 : 849.
Khilnani P, Goldstein B, Todres ID. Double Lumen umbilica venous catheters in critically ill neonates: A randomized prospective study.Crity Care Med 1991; 19 : 1348–1351.
Chatas MK, Paton JB, Fisher DE. Percutaneous central venous catheterization: 3 years experience in a neonatal intensive care unit.AJDC 1990; 144 : 1246–1250.
Kacica MA, Horgan MJ, Ochoa L, Sandier R, Lepow ML, Venezia RA. Prevention of gram positive sepsis in neonates weighing less than 1500 grams.J Pediatr 1994; 125: 253–258.
Spafford PS, Sinkin RA, Cox C, Reubens L, Powell KR. Prevention of central venous catheter-related coagulase-negative staphylococcal sepsis in neonates.J Pediatr 1994; 125: 259–263.
Barefield ES, Phillips JB III. Vancomycin prophylaxis for coagulase-negative staphyococcal bactermia.J Pediatr 1994; 125: 230–232.
Maki DG, Ringer M, Alvardo CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arteial catheters.Lancet 1991; 338: 339–343.
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Bhandari, V., Eisenfeld, L., Lerer, T. et al. Nosocomial sepsis in neonates with single lumen vascular catheters. Indian J Pediatr 64, 529–535 (1997). https://doi.org/10.1007/BF02737762
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DOI: https://doi.org/10.1007/BF02737762