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Central line-associated bloodstream infections may be related to catheter duration

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The incidence rate of central line-associated bloodstream infections increased by 33% per day after 35 days and remained elevated afterward for those infants requiring a peripherally inserted central venous catheter, according to data from a recent study.

Researchers at The Johns Hopkins Hospital in Baltimore conducted a retrospective cohort study of 683 newborns in the neonatal intensive care unit who had peripherally inserted central venous catheters inserted between Jan. 1, 2006, and Dec. 31, 2008.

Central line-associated bloodstream infections (CLA-BSIs) occurred in 21 patients within a follow-up period of 10,470 catheter-days (exposure time), according to the researchers, with a median of 12 catheter-days per patient.

Results indicated that the incidence of peripherally inserted central venous catheter-associated CLA-BSI was 2.01 per 1,000 catheter-days (95% CI, 1.24-3.06). Additionally, the researchers said incidence rates increased by 14% per day during the first 18 days of insertion. The median time from insertion to infection was 18 days.

Of the 21 patients who developed CLA-BSIs, 61.9% were boys; 76.2% had a birth weight less than 1,500 g; 80.9% had a gestational age less than 32 weeks; and 61.9% were 7 days old or younger. However, the researchers said there was no statistically significant relationship between these factors and a higher risk of CLA-BSI.

“Our findings showed a dramatic increase in daily infection risk for each day beyond day 35,” lead investigator Aaron Milstone, MD, MHS, a pediatric infectious disease specialist at Johns Hopkins Children’s Center, said in a press release. “Our message to [neonatal intensive care unit] staff is simple: Remain vigilant and consider replacement around day 35.”

Each year, 80,000 central line infections occur in the United States, researchers estimate, and up to one-fifth of patients who get them will die. In one study of pediatric intensive care unit patients, researchers found that each infection prolongs the hospital stay by one week on average, and another study showed that these infections can cost up to $29,000 per patient.

Sengupta A. Pediatrics. 2010;125:648-653.