Use of silver-impregnated umbilical venous catheters for prevention of catheter associated bloodstream infection in neonates
Use of silver-impregnated umbilical venous catheters for prevention of catheter associated bloodstream infection in neonates
Aim: Neonates hospitalized in neonatal intensive care units (NICU)s often require a venous access. Umbilical venous catheter (UVC) is the commonly used one. UVCs are known to cause life-threatening complications such as catheter-associated bloodstream infections (CABSI). To the best of our knowledge, our unit is the first and only NICU in Turkey that used silver-impregnated UVCs. This study aims to evaluate the impact of silver-impregnated UVC insertion on the incidence of CABSI. Materials and Methods: A total of 108 patients were included in this retrospective study. After the application of exclusion criteria, the control group was composed of neonates (n=58) who had polyurethane (PU) UVCs inserted and the study group consisted of infants (n=41) who had silver-impregnated UVCs inserted. Demographic and clinical data of the mothers and neonates including duration of UVC insertion and sepsis incidence were collected and compared statistically. Results: There was no statistically significant difference between the groups except for intubation period and mortality. One neonate in each group had CABSI (p=1). Four neonates, two in each group, were diagnosed with clinical sepsis. Total CABSI incidence in our whole population was 2% and 3.3 per 1000 catheter days. Conclusion: Strict precautions should be taken to prevent infection in every unit. In NICUs with low incidence of sepsis, silverimpregnated UVCs may have no further effect in the reduction of CABSI.
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- 1. Lindquist S, Hentz E, Tessin I, et al. Very low birthweight infants face an increased risk of bloodstream infections following the removal of umbilical catheters. Acta Paediatr 2016;105:391-6.
- 2. Arnts IJ, Bullens LM, Groenewoud JM, et al. Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns. J Obstet Gynecol Neonatal Nurs 2014;43:205-15.
- 3. Shahid S, Dutta S, Symington A, et al. Standardizing umbilical catheter usage in preterm infants. Pediatrics 2014;133:1742-52.
- 4. Dongara AR, Patel DV, Nimbalkar SM, et al. Umbilical Venous Catheter Versus Peripherally Inserted Central Catheter in Neonates: A Randomized Controlled Trial. J Trop Pediatr 2017;63:374-9.
- 5. Shalabi M, Adel M, Yoon E, et al; Canadian Neonatal Network. Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates. Pediatrics 2015;136:1073-9.
- 6. Pereira GR, Lim BK, Ing C, et al. Umbilical vs peripheral vein catheterization for parenteral nutrition in sick premature neonates. Yonsei Med J 1992;33:224-31.
- 7. Sobczak A, Klepacka J, Amrom D, et al. Umbilical catheters as vectors for generalized bacterial infection in premature infants regardless of antibiotic use. J Med Microbiol 2019;68:1306-13.
- 8. Goh SSM, Kan SY, Bharadwaj S, et al. A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore. Singapore Med J 2019.
- 9. Yadav S, Dutta AK, Sarin SK. Do umbilical vein catheterization and sepsis lead to portal vein thrombosis? A prospective, clinical, and sonographic evaluation. J Pediatr Gastroenterol Nutr 1993;17:392- 6.
- 10. Oelberg DG, Baker A, Quast D, et al. Impact of umbilical catheterization on morbidity and mortality in extremely premature newborns. J Neonatal Perinatal Med 2014;7:13-9.
- 11. Butler-O'Hara M, Buzzard CJ, Reubens L, et al. A randomized trial comparing long-term and shortterm use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics 2006;118:25-35.
- 12. Chien LY, Macnab Y, Aziz K, et al; Canadian Neonatal Network. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002;21:505-11.
- 13. Schulman J, Stricof R, Stevens TP, et al.; Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127:436-44.
- 14. Yumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr 2013;102:293-8.
- 15. Bertini G, Elia S, Ceciarini F, et al. Reduction of catheterrelated bloodstream infections in preterm infants by the use of catheters with the AgION antimicrobial system. Early Hum Dev 2013;89:21-5.
- 16. Antonelli M, De Pascale G, Ranieri VM, et al. Comparison of triple-lumen central venous catheters impregnated with silver nanoparticles (AgTive®) vs conventional catheters in intensive care unit patients. J Hosp Infect 2012;82:101-7.
- 17. Wang H, Huang T, Jing J, et al. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis. J Hosp Infect 2010;76:1-11.
- 18. Lorente L, Lecuona M, Jiménez A, et al. Chlorhexidinesilver sulfadiazine- or rifampicin-miconazoleimpregnated venous catheters decrease the risk of catheter-related bloodstream infection similarly. Am J Infect Control 2016;44:50-3.
- 19. Hockenhull JC, Dwan K, Boland A, et al. The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation. Health Technol Assess 2008;12:1-154.
- 20. Ramritu P, Halton K, Collignon P, et al. A systematic review comparing the relative effectiveness of antimicrobial-coated catheters in intensive care units. Am J Infect Control 2008;36:104-17.
- 21. Guggenbichler JP, Bo¨swald M, Lugauer S, et al. A new technology of microdispersed silver in polyurethane induces antimicrobial activity in central venous catheters. Infection 1999;27:16-23.
- 22. Gilbert RE, Mok Q, Dwan K, et al; CATCH trial investigators. Impregnated central venous catheters for prevention of bloodstream infection in children (the CATCH trial): a randomised controlled trial. Lancet 2016;387:1732-42.
- 23. Gallacher DJ, Hart K, Kotecha S. Common respiratory conditions of the newborn. Breathe (Sheff) 2016;12:30- 42.
- 24. Principi N, Di Pietro GM, Esposito S. Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies. J Transl Med 2018;16:36.
- 25. Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-34.
- 26. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7.
- 27. O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheterrelated infections. www. cdc.gov/hicpac/bsi/bsiguidelines-2011.html 2011
- 28. 28. Balain M, Oddie SJ, McGuire W. Antimicrobialimpregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants. Cochrane Database Syst Rev 2015;(9):CD011078.
- 29. Hei MY, Zhang XC, Gao XY, et al. Catheter-related infection and pathogens of umbilical venous catheterization in a neonatal intensive care unit in China. Am J Perinatol 2012;29:107-14.
- 30. Turkish Neonatal Society; Nosocomial Infections Study Group. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010;52:50-7.
- 31. L’Hériteau F, Lacavé L, Leboucher B, et al, le comité de pilotage du Réseau NEOCAT. [NEOCAT, surveillance network of catheter-related bloodstream infections in neonates: 2010 data]. Arch Pediatr 2012;19:984-9.
- 32. Camara D. Minimizing risks associated with peripherally inserted central catheters in the NICU. MCN Am J Matern Child Nurs 2001;26:17-21.
- 33. Al Raiy B, Fakih MG, Bryan-Nomides N, et al. 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 2010;38:149-53
- 34. Konstantinidi A, Sokou R, Panagiotounakou P, et al. Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study. Medicina (Kaunas) 2019;55:442.
- 35. Loertzer H, Soukup J, Hamza A, et al. Use of catheterswith the AgION antimicrobial system in kidney transplant recipients to reduce infec-tion risk. Transplant Proc 2006;38:707-10.
- 36. Corral L, Nolla-Salas M, Iban ̃ez-Nolla J, et al. A prospective,randomized study in critically ill patients using the Oligon Vantexcatheter. J Hosp Infect 2003;55:212-9.
- 37. Ranucci M, Isgro`G, Giomarelli PP, et al. Impact of oligon centralvenous catheters on catheter colonization and catheter-relatedbloodstream infection. Crit Care Med 2003;31:52-9.
- 38. Carbon RT, Lugauer S, Geitner U, et al. Reducing catheter-associated infections with silverimpregnated catheters in long-term therapy of children. Infection 1999;27:69-73.
- 39. Gilbert RE, Harden M. Effectiveness of impregnated central venous catheters for catheter related blood stream infection: a systematic review. Curr Opin Infect Dis 2008;21:235-45.
- 40. Gilbert R, Brown M, Rainford N, et al. PREVAIL trial team. Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial. Lancet Child Adolesc Health 2019;3:381-90.