Download PDF
J Pediatr Intensive Care 2022; 11(03): 240-246
DOI: 10.1055/s-0041-1723946
Original Article

Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience

Rudrashish Haldar
1   Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Ankur Mandelia 
2   Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Prabhaker Mishra 
3   Department of Biostatistics & Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Ashwani Mishra
2   Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Yousuf Siddiqui
2   Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

The purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age (p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5–8] days) and CRBSI (6 [5–9] days) patients (p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization (p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.

Keywords

central venous catheter - catheter-related bloodstream infection - pediatric - surgery - children - central line - colonization

Authors' Contributions

All authors contributed to the study conception and design. Material preparation and data retrieval were performed by R.H. and A.M. Statistical analyses were done by P.M. and A.M. The first draft of the manuscript was written by R.H. and A.M. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was waived in view of the retrospective nature of the study and all the procedures performed were part of the routine care.




Publication History

Received: 30 October 2020

Accepted: 03 January 2021

Article published online:
17 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Beekmann SE, Henderson DK. Infections caused by percutaneous intravascular devices. In: Mandell GL, Bennett JE, Dolin R. eds. Principles and Practice of Infectious Disease. Vol 1, 6th edition. Philadelphia: PA: Elsevier; 2005: 3347-3361
    Google Scholar
  • 2 Maki DG, Ringer M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters. Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing. JAMA 1987; 258 (17) 2396-2403
    CrossrefPubMedGoogle Scholar
  • 3 Liñares J, Sitges-Serra A, Garau J, Pérez JL, Martín R. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J Clin Microbiol 1985; 21 (03) 357-360
    CrossrefPubMedGoogle Scholar
  • 4 Mermel LA, Allon M, Bouza E. et al. 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 (01) 1-45
    CrossrefPubMedGoogle Scholar
  • 5 Wilson MZ, Rafferty C, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am J Infect Control 2014; 42 (11) 1157-1160
    CrossrefPubMedGoogle Scholar
  • 6 Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014; 133 (06) e1525-e1532
    CrossrefPubMedGoogle Scholar
  • 7 Rao S, Alladi A, Das K, Cruz AJD. Medium and long term central venous access in children. Indian Pediatr 2003; 40 (01) 41-44
    PubMedGoogle Scholar
  • 8 Chopdekar K, Chande C, Chavan S. et al. Central venous catheter-related blood stream infection rate in critical care units in a tertiary care, teaching hospital in Mumbai. Indian J Med Microbiol 2011; 29 (02) 169-171
    CrossrefPubMedGoogle Scholar
  • 9 Sachdev A, Gupta DK, Soni A, Chugh K. Central venous catheter colonization and related bacteremia in pediatric intensive care unit. Indian Pediatr 2002; 39 (08) 752-760
    PubMedGoogle Scholar
  • 10 Jarvis WR, Edwards JR, Culver DH. et al; National Nosocomial Infections Surveillance System. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991; 91 (3B): 185S-191S
    CrossrefPubMedGoogle Scholar
  • 11 Odetola FO, Moler FW, Dechert RE, VanDerElzen K, Chenoweth C. Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 2003; 4 (04) 432-436
    CrossrefPubMedGoogle Scholar
  • 12 García-Teresa MA, Casado-Flores J, Delgado Domínguez MA. et al; Spanish Central Venous Catheter Pediatric Study Group. Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study. Intensive Care Med 2007; 33 (03) 466-476
    CrossrefPubMedGoogle Scholar
  • 13 Costello JM, Graham DA, Morrow DF, Potter-Bynoe G, Sandora TJ, Laussen PC. Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatr Crit Care Med 2009; 10 (04) 453-459
    CrossrefPubMedGoogle Scholar
  • 14 Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of Central venous access devices: a systematic review. Pediatrics 2015; 136 (05) e1331-e1344
    CrossrefPubMedGoogle Scholar
  • 15 García H, Romano-Carro B, Miranda-Novales G, González-Cabello HJ, Núñez-Enríquez JC. Risk factors for central line-associated bloodstream infection in critically ill neonates. Indian J Pediatr 2019; 86 (04) 340-346
    CrossrefPubMedGoogle Scholar
  • 16 Niedner MF, Huskins WC, Colantuoni E. et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol 2011; 32 (12) 1200-1208
    CrossrefPubMedGoogle Scholar
  • 17 Blanchard AC, Fortin E, Rocher I. et al. Central line-associated bloodstream infection in neonatal intensive care units. Infect Control Hosp Epidemiol 2013; 34 (11) 1167-1173
    CrossrefPubMedGoogle Scholar
  • 18 Coffin SE, Klieger SB, Duggan C. et al; Pediatric Prevention EpiCenter Consortium. Central line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections. Infect Control Hosp Epidemiol 2014; 35 (11) 1391-1399
    CrossrefPubMedGoogle Scholar
  • 19 Dahan M, O'Donnell S, Hebert J. et al. CLABSI risk factors in the NICU: potential for prevention: a PICNIC study. Infect Control Hosp Epidemiol 2016; 37 (12) 1446-1452
    CrossrefPubMedGoogle Scholar
  • 20 Gatt M, Reddy BS, MacFie J. Review article: bacterial translocation in the critically ill--evidence and methods of prevention. Aliment Pharmacol Ther 2007; 25 (07) 741-757
    CrossrefPubMedGoogle Scholar
  • 21 MacFie J, Reddy BS, Gatt M, Jain PK, Sowdi R, Mitchell CJ. Bacterial translocation studied in 927 patients over 13 years. Br J Surg 2006; 93 (01) 87-93
    CrossrefPubMedGoogle Scholar
  • 22 Quach C, Milstone AM, Perpête C, Bonenfant M, Moore DL, Perreault T. Chlorhexidine bathing in a tertiary care neonatal intensive care unit: impact on central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2014; 35 (02) 158-163
    CrossrefPubMedGoogle Scholar
  • 23 Smith MJ. Catheter-related bloodstream infections in children. Am J Infect Control 2008; 36 (10) S173.e1-S173.e3
    CrossrefPubMedGoogle Scholar
  • 24 Mahieu LM, De Muynck AO, Ieven MM, De Dooy JJ, Goossens HJ, Van Reempts PJ. Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit. J Hosp Infect 2001; 48 (02) 108-116
    CrossrefPubMedGoogle Scholar
  • 25 Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011; 60 (08) 243-248
    PubMedGoogle Scholar
  • 26 Greenberg RG, Cochran KM, Smith PB. et al. Effect of catheter dwell time on risk of central line-associated bloodstream infection in infants. Pediatrics 2015; 136 (06) 1080-1086
    CrossrefPubMedGoogle Scholar
  • 27 Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol 2011; 32 (01) 42-49
    CrossrefPubMedGoogle Scholar
  • 28 Milstone AM, Reich NG, Advani S. et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics 2013; 132 (06) e1609-e1615
    CrossrefPubMedGoogle Scholar
  • 29 Sengupta A, Lehmann C, Diener-West M, Perl TM, Milstone AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics 2010; 125 (04) 648-653
    CrossrefPubMedGoogle Scholar
  • 30 Smith PB, Benjamin Jr DK, Cotten CM. et al. Is an increased dwell time of a peripherally inserted catheter associated with an increased risk of bloodstream infection in infants?. Infect Control Hosp Epidemiol 2008; 29 (08) 749-753
    CrossrefPubMedGoogle Scholar
  • 31 Miller JW, Vu DN, Chai PJ. et al. Upper body central venous catheters in pediatric cardiac surgery. Paediatr Anaesth 2013; 23 (11) 980-988
    CrossrefPubMedGoogle Scholar
  • 32 Centers for Disease Control and Prevention. Guidelines for the Prevention of Intravascular Catheter-Related Infections. 2011 . Accessed January 26, 2021 at: https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html
    PubMedGoogle Scholar
  • 33 Casado-Flores J, Barja J, Martino R, Serrano A, Valdivielso A. Complications of central venous catheterization in critically ill children. Pediatr Crit Care Med 2001; 2 (01) 57-62
    CrossrefPubMedGoogle Scholar
  • 34 Sun Y, Wan G, Liang L. Taurolidine lock solution for catheter-related bloodstream infections in pediatric patients: a meta-analysis. PLoS One 2020; 15 (04) e0231110
    CrossrefPubMedGoogle Scholar
  • 35 Timsit JF, Baleine J, Bernard L. et al. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care 2020; 10 (01) 118
    CrossrefPubMedGoogle Scholar