Catheter Dwell Time and Risk of Bloodstream Infections in Hospitalized Neonates

描述（由申请人提供）：静脉（IV）通路对于为住院新生儿提供液体、药物和营养至关重要。自20世纪80年代以来，外周插入中心静脉导管（PICC）已越来越多地用于提供IV通路。PICC可以放置在床边，而无需全身麻醉，并且可以保持数天或数周，机械并发症似乎很小。然而，并发症确实会发生，包括中心线相关血流感染（CLA-BSI）、静脉炎、蜂窝织炎和血栓形成。CLA-BSI具有显著的可归因成本和高达20%的相关死亡率。本研究的长期目标是进一步制定循证策略，以预防在新生儿重症监护室住院的婴儿中发生中心静脉导管相关血流感染（CLA-BSI）。该提案建立了一个多中心儿科协作，以检查该独特人群中导管留置时间与CLA-BSI之间的相关性。 许多研究表明，导管留在原位的时间越长，并发症的风险就越大。然而，医疗保健提供者认为并发症的风险每天都是恒定的。我们假设：1）在新生儿重症监护室（NICU）住院的儿童中，PICC相关CLA-BSI的每日风险并不恒定，2）在PICC插入后约一个月，存在一个阈值，超过该阈值，CLA-BSI的每日风险显著增加。本提案将确定PICC相关CLA-BSI的风险在导管留置时间内是否恒定，并确定是否存在阈值，超过该阈值，CLA-BSI的每日风险显著增加。为了完成该项目，我们将进行一项多中心回顾性队列研究，以收集和表征来自七个三级护理NICU的数据。我们将评价PICC相关CLA-BSI的风险因素，重点关注导管留置时间作为CLA-BSI的非线性独立预测因素。 PICC对住院新生儿的护理至关重要，但CLA-BSI具有显著的死亡率和相关的经济成本。如果CLA-BSI随时间变化的风险不恒定，则新生儿可能会因延长PICC持续时间而面临不必要的风险。随着PICC继续广泛用于其他医疗机构和人群，该合作项目的结果应刺激更多的研究，以提高护理质量和预防医疗相关感染。我们的长期目标是为制定预防措施提供基于证据的理由，这些措施可以挽救生命并降低医疗成本。 公共卫生相关性：血流感染是发病率和经济成本的重要原因。该项目将有助于制定循证战略，以预防新生儿重症监护室住院的脆弱婴儿的血液感染。

DESCRIPTION (provided by applicant): Intravenous (IV) access is essential to provide fluids, medications and nutrition to hospitalized neonates. Since the 1980s, peripherally inserted central venous catheters (PICC) have been increasingly used to provide IV access. PICCs can be placed at the bedside without general anesthesia and can remain in place for days or weeks with seemingly minimal mechanical complications. However, complications do occur, including central-line associated bloodstream infections (CLA-BSI), phlebitis, cellulitis, and thrombosis. CLA-BSIs have a significant attributable cost and an associated mortality of up to 20%. The long-term objective of this research is to further develop evidence-based strategies to prevent central-line associated bloodstream infections (CLA-BSI) among infants hospitalized in the neonatal intensive care unit. This proposal builds a multicenter pediatric collaborative to examine the association between catheter dwell time and CLA-BSI in this unique population. Many studies have shown that the longer a catheter remains in the place, the greater the risk of complication. However, healthcare providers assume that the risk of a complication is constant from day to day. We hypothesize that 1) the daily risk of PICC-associated CLA-BSI in children hospitalized in the neonatal intensive care unit (NICU) is not constant, and 2) approximately one month after PICC insertion, a threshold exists beyond which time the daily risk of CLA-BSI significantly increases. This proposal will determine if the risk of PICC- associated CLA-BSI is constant over catheter dwell time, and identify whether a threshold exists beyond which the daily risk of CLA-BSI significantly increases. To complete this project we will perform a multicenter retrospective cohort study to collect and characterize data from seven tertiary care NICUs. We will evaluate risk factors for PICC-associated CLA-BSI, focusing on catheter dwell time as a non-linear independent predictor of CLA-BSI. PICCs are essential to the care of hospitalized neonates, but CLA-BSI have significant mortality and associated financial costs. Neonates may face unnecessary risk from prolonged PICC duration if the risk of CLA-BSI over time is not constant. As PICCs continue to be used widely in other healthcare settings and populations, findings from this collaborative project should stimulate additional studies to improve quality of care and prevent healthcare-associated infections. Our long-term goal is to provide evidence-based justification for instituting preventive measures which could save lives and reduce healthcare costs. PUBLIC HEALTH RELEVANCE: Bloodstream infections are a significant cause of morbidity and financial costs. This project will help to develop evidence-based strategies to prevent bloodstream infections among vulnerable infants hospitalized in the neonatal intensive care unit.