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.

Autor: Yamaguchi RS; Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil. ryamaguchi@prestadores.amil.com.br.; Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil. ryamaguchi@prestadores.amil.com.br.; Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. ryamaguchi@prestadores.amil.com.br., Noritomi DT; Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil., Degaspare NV; Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.; Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil.; Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil., Muñoz GOC; Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.; Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil.; Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil., Porto APM; Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil., Costa SF; Laboratory of Bacteriology (LIM 54), Department of Infectious Diseases, Medical School, University of São Paulo, São Paulo, Brazil., Ranzani OT; Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.; Pulmonary Division, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.; Department of Pulmonology, Hospital Clinic of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2017 Aug; Vol. 43 (8), pp. 1097-1104. Date of Electronic Publication: 2017 Jun 05.
DOI: 10.1007/s00134-017-4852-7
Abstrakt: 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.
Databáze: MEDLINE
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