Catheter duration and risk of CLA-BSI in neonates with PICCs.
Catheter duration and risk of CLA-BSI in neonates with PICCs.
复制标题
DOI：
10.1542/peds.2009-2559
复制
发表时间：
2010-04
期刊：
影响因子：
8
通讯作者：
Milstone AM
中科院分区：
文献类型：
--
作者：
Sengupta A;Lehmann C;Diener-West M;Perl TM;Milstone AM
确定高危新生儿外周插入中心静脉导管（PICC）期间中心静脉导管相关血流感染（CLA-BSI）的风险是否保持恒定。我们对2006年1月1日至2008年12月31日期间插入PICC的NICU患者进行了一项回顾性队列研究。使用Poisson回归模型（具有线性样条项）对PICC插入后的时间进行建模，以评估CLA-BSI风险的潜在变化，同时调整其他变量。683例新生儿符合分析条件。在10，470个导管日的随访时间内发生了21例CLA-BSI。PICC相关CLA-BSI的发生率为2.01/1000导管日（95% CI=1.24，3.06）。在PICC插入后的前18天内，CLA-BSI的发生率每天增加14%（发生率比[IRR] 1.14; CI 1.04，1.25）。从PICC插入后第19天到第35天，趋势发生逆转（IRR 0.8; 95% CI 0.66，0.96）。从PICC插入后第36天到第60天，CLA-BSI的发生率再次以每天33%的速度增加（IRR 1.33; 95% CI 1.12，1.57）。胎龄组、出生体重组和实足年龄组与CLA-BSI风险之间无统计学显著相关性。我们的数据表明，导管持续时间是NICU中PICC相关CLA-BSI的重要风险因素。35天后CLA-BSI风险每日显著增加，如果超过该时间段需要血管内通路，则可能需要更换PICC。
To determine whether the risk of central line-associated bloodstream infections (CLA-BSI) remained constant over the duration of peripherally inserted central venous catheters (PICC) 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. 683 neonates were eligible for analysis. There were 21 CLA-BSIs within a follow-up time of 10,470 catheter days. The incidence of PICC-associated CLA-BSI was 2.01 per thousand catheter days (95% CI=1.24, 3.06). The incidence rate of CLA-BSI increased by 14% per day during the first 18 days following PICC insertion (incidence rate ratio [IRR] 1.14; 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 once again increased by 33% per day (IRR 1.33; 95% CI 1.12, 1.57). There was no statistically significant association between gestational age groups, birth weight groups, and chronological age groups with the risk of CLA-BSI. 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.