Catheter duration and risk of CLA-BSI in neonates with PICCs
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. PEDIATRICS
(Impact Factor: 5.47).
03/2010; 125(4):648-53. DOI: 10.1542/peds.2009-2559
To determine whether the risk of central line-associated bloodstream infections (CLA-BSIs) remained constant over the duration of peripherally inserted central venous catheters (PICCs) in high-risk neonates.
We performed a retrospective cohort study of NICU patients who had a PICC inserted between January 1, 2006, and December 31, 2008. A Poisson regression model with linear spline terms to model time since PICC insertion was used to evaluate potential changes in the risk of CLA-BSI while adjusting for other variables.
Six hundred eighty-three neonates were eligible for analysis. There were 21 CLA-BSIs within a follow-up period of 10 470 catheter-days. The incidence of PICC-associated CLA-BSI was 2.01 per 1 000 catheter-days (95% confidence interval [CI]: 1.24-3.06). The incidence rate of CLA-BSIs increased by 14% per day during the first 18 days after PICC insertion (incidence rate ratio [IRR]: 1.14 [95% CI: 1.04-1.25]). From days 19 through 35 after PICC insertion, the trend reversed (IRR: 0.8 [95% CI: 0.66-0.96]). From days 36 through 60 after PICC insertion, the incidence rate of CLA-BSI again increased by 33% per day (IRR: 1.33 [95% CI: 1.12-1.57]). There was no statistically significant association between the risk of CLA-BSI and gestational age groups, birth weight groups, or chronological age groups.
Our data suggest that catheter duration is an important risk factor for PICC-associated CLA-BSI in the NICU. A significant daily increase in the risk of CLA-BSI after 35 days may warrant PICC replacement if intravascular access is necessary beyond that period.
Available from: Piotr B Heczko
- "Our data focusing on infections associated with vascular lines do differ substantially from those published by other centers e.g. NeoKISS . The CVC-BSI in our total study population was greater than 8.6/1000 CVC days, while in the NeoKISS surveillance it was 13.8/1000 CVC days during the initial year of reporting. "
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Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011.
The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS.
Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%).
Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio.
BMC Infectious Diseases 06/2014; 14(1):339. DOI:10.1186/1471-2334-14-339 · 2.61 Impact Factor
Available from: Birgitte Bak-Jensen
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ABSTRACT: In this paper, the authors present a result of a full-scale earth fault test carried out on the 10 kV research/laboratory distribution network at Kyndbyvaerket Denmark in May 2001. The network is compensated through a Petersen-Coil and current and voltage measurements were measured on conventional current transformers (CTs) and voltage transformers (VTs) by an optical link. Comparison with a similar earlier performed experiment carried out autumn 1998, where current and voltage measurements were measured with high bandwidth Rogowski coils and high voltage Tektronix probes, gave remarkable results. The necessity of high bandwidth measurement equipment for earth fault measurements on compensated distribution networks can be undermined, since it will be shown that the transient signal transfer through conventional CTs and VTs for further signal analysis is sufficient. Caused by the inadequacy three phase conductor cable models in PSCDAD/EMTDC<sup>®</sup> V3, the simulations of the whole laboratory network shows more or less good identity with the measurements.
Power Engineering Society Summer Meeting, 2002 IEEE; 08/2002
Available from: Yhu-Chering Huang
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ABSTRACT: To compare the complication rates of femoral versus nonfemoral sites of percutaneously inserted central venous catheters (PICCs) in very low birth weight infants.
Between 2004 and 2006, 518 PICCs inserted in 334 neonates with a birth body weight>or=1500 g were studied. 278 catheters were inserted at nonfemoral sites, and 240 catheters at a femoral site. All catheter-related complications were recorded and analyzed.
The infants with femoral PICCs had a significantly higher rate of catheter-related sepsis (CRS) than those with nonfemoral PICCs (22.5% vs. 12.2%, P=0.002) and the incidence rate was also significantly higher (10.9 vs. 6.8 episodes per 1000 catheter days, P=0.012). The infants with nonfemoral PICCs had significantly higher rates of phlebitis, catheter site inflammation, and need for early removal than those with femoral PICCs. Multiple logistic regression analysis showed that the significant contributors to CRS were duration of the PICC placement (P<0.001) and insertion of the PICC at a femoral site (P=0.010).
Because of a higher rate of CRS, the femoral site should not be considered for the placement of PICCs in VLBW infants, when possible.
The Pediatric Infectious Disease Journal 09/2009; 28(11):966-70. DOI:10.1097/INF.0b013e3181aa3a29 · 2.72 Impact Factor
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