Hasan AĞIN, İlker DEVRİM, Gökhan CEYLAN, Rana İŞGÜDER, Ahu KARA, Gamze GÜLFİDAN

Risk factors for recurrent central line-associated bloodstream infections in a pediatric intensive care unit

Background/aim: It is recommended that a central venous catheter (CVC) be removed if central line-associated bloodstream infection (CLABSI) has been diagnosed. The objective of this retrospective study was to evaluate the risk factors for recurrent CLABSI in reinserted catheters in a pediatric intensive care unit. Materials and methods: Patients with recurrent and nonrecurrent CLABSI were compared in terms of the catheter exchange interval, the interval between negative blood culture and reinsertion of the CVC, and the pre-/reinsertion treatment duration. Results: Thirty-one patients with initial CLABSI had reinserted CVCs, and 12 (38.7%) of these patients were diagnosed with recurrent CLABSI. In the recurrent group, the catheter exchange interval, the interval between negative blood culture and reinsertion of the second CVC, and pre-/reinsertion treatment duration were found to be shorter. Logistic regression analysis revealed that if the interval between negative blood culture and reinsertion of the second CVC was shorter than 4 days, recurrent CLABSI risk increased by 1.7-fold (P = 0.021). Sterile gauze-dressed patients had shorter cumulative catheter surveys than the polyurethane-dressed patients (P = 0.005). Conclusion: Using transparent polyurethane dressings instead of sterile gauze for maintaining the CVC and delaying the reinsertion procedure for at least 4 days after the negative culture might be helpful in preventing recurrent CLABSI.

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1. Hatler C, Buckwald L, Salas-Allison Z, Murphy-Taylor C. Evaluating central venous catheter care in a pediatric intensive care unit. Am J Crit Care 2009; 18: 514-520.
2. Randolph AG, Brun-Buisson C, Goldmann D. Identification of central venous catheter-related infections in infants and children. Pediatr Crit Care Med 2005; 6: 19-24.
3. Tomlinson D, Mermel LA, Ethier MC, Matlow A, Gillmeister B, Sung L. Defining bloodstream infections related to central venous catheters in patients with cancer: a systematic review. Clin Infect Dis 2011; 53: 697-710.
4. OGrady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011; 39: 1-34.
5. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, OGrady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49: 1-45.
6. Flynn PM, Willis B, Gaur AH, Shenep JL. Catheter design influences recurrence of catheter-related bloodstream infection in children with cancer. J Clin Oncol 2003; 21: 35.
7. Chin BS, Han SH, Lee HS, Jeong SJ, Choi H, Kim CO, Choi JY, Song YG, Kim JM. Risk factors for recurrent catheter-related infections after catheter-related bloodstream infections. Int J Infect Dis 2010;14: 16-21.
8. Erbay A, Ergönül O, Stoddard GJ, Samore MH. Recurrent catheter-related bloodstream infections: risk factors and outcome. Int J Infect Dis. 2006; 10: 396-400.
9. Centers for Disease Control and Prevention. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line-Associated Bloodstream Infection. Atlanta, GA, USA: CDC; 2017.
10. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24: 743- 752.
11. Thomas D, Parameswaran N, Harish BN. Catheter related blood stream infections in the paediatric intensive care unit: a descriptive study. Indian J Crit Care Med 2013; 17: 135-139.
12. Hammarskjöld F, Berg S, Hanberger H, Taxbro K, Malmvall BE. Sustained low incidence of central venous catheter-related infections over six years in a Swedish hospital with an active central venous catheter team. Am J Infect Control 2014; 42: 122- 128.
13. Krishnaiah A, Soothill J, Wade A, Mok QQ, Ramnarayan P. Central venous catheter-associated bloodstream infections in a pediatric intensive care unit: effect of the location of catheter insertion. Pediatr Crit Care Med 2012; 13: 176-180.
14. Rey C, Alvarez F, De-La-Rua V, Concha A, Medina A, Díaz JJ, Menéndez S, Los-Arcos M, Mayordomo-Colunga J. Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit. Intensive Care Med 2011; 37: 678-685
15. Wylie MC, Graham DA, Potter-Bynoe G, Kleinman ME, Randolph AG, Costello JM, Sandora TJ. Risk factors for central line-associated bloodstream infection in pediatric intensive care units. Infect Cont Hosp Ep 2010; 31: 1049-1056.
16. Pinon M, Bezzio S, Tovo PA, Fagioli F, Farinasso L, Calabrese R, Marengo M, Giacchino M. A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. Eur J Pediatr 2009; 168: 1505-1512.
17. Ağın H, Devrim I, İşgüder R, Karaarslan U, Kanık E, Günay İ, Kışla M, Aydın S, Gülfidan G. Risk factors for candidemia in pediatric intensive care unit patients. Indian J Pediatr 2014; 81: 1158-1162.
18. Hirai Y, Asahata S, Ainoda Y, Goto A, Fujita T, Totsuka K. Nosocomial Candida parapsilosis candidaemia: risk factors, antifungal susceptibility and outcome. J Hosp Infect 2014; 87: 54-58.
19. Holland LM, Schröder MS, Turner SA, Taff H, Andes D, Grózer Z, Gácser A, Ames L, Haynes K, Higgins DG et al. Comparative phenotypic analysis of the major fungal pathogens Candida parapsilosis and Candida albicans. PLoS Pathog 2014; 10: e1004365.
20. Garnacho-Montero J, Díaz-Martín A, García-Cabrera E, Ruiz Pérez de Pipaón M, Hernández-Caballero C, Lepe-Jiménez JA. Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections. J Antimicrob Chemoth 2013; 68: 206-213.
21. Nucci M, Anaissie E. Should vascular catheters be removed from all patients with candidemia? An evidence-based review. Clin Infect Dis 2002; 34: 591-599.
22. Nucci M, Anaissie E, Betts RF, Dupont BF, Wu C, Buell DN, Kovanda L, Lortholary O. Early removal of central venous catheter in patients with candidemia does not improve outcome: analysis of 842 patients from 2 randomized clinical trials. Clin Infect Dis 2010; 51: 295-303.
23. Velasco E, Portugal RD. Factors prompting early central venous catheter removal from cancer patients with candidaemia. Scand J Infect Dis 2011; 43: 27-31.
24. Downes KJ, Metlay JP, Bell LM, McGowan KL, Elliott MR, Shah SS. Polymicrobial bloodstream infections among children and adolescents with central venous catheters evaluated in ambulatory care. Clin Infect Dis 2008; 46: 387-394.
25. Perlman SE, Saiman L, Larson EL. Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 2007; 35: 177-182.
26. Webster J, Gillies D, ORiordan E, Sherriff KL, Rickard CM. Gauze and tape and transparent polyurethane dressings for central venous catheters. Cochrane Database Syst Rev 2011; 11: CD003827.