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

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.

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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.

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Correspondence to Ricardo Silveira Yamaguchi.

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Additional information

Take-home message: PICCs could be used as an alternative to CVCs in Paediatric ICUs. We observed that in four PICUs from Brazil, PICCs were commonly used instead of CVCs.

We showed for the first time in a multicentre study that PICCs were associated with a protective effect in CLABSI prevention in paediatric critical care setting.

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Yamaguchi, R.S., Noritomi, D.T., Degaspare, N.V. et al. 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. Intensive Care Med 43, 1097–1104 (2017). https://doi.org/10.1007/s00134-017-4852-7

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Keywords

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