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Arterial catheter-related infections in children. A 1-year cohort analysis
S Furfaro1, M Gauthier, J Lacroix
1Department of Pediatrics, St-Justine Hospital, University of Montreal, Quebec, Canada.
Insights
Pediatric arterial catheter infections are rare. Most catheters remain sterile, with infection risk low and not increasing significantly with duration after 48 hours, making routine reinsertion unnecessary.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Medical Device Safety
Background:
- Arterial catheterization is common in pediatric intensive care units.
- Understanding infection rates and risk factors is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of infection from arterial catheterization in children.
- To identify risk markers associated with these infections.
Main Methods:
- Prospective evaluation of all arterial catheters in a pediatric intensive care unit over one year.
- Analysis of 340 catheters placed in 310 children.
- Categorization of catheters into sterile, contaminated, and infected groups based on cultures.
Main Results:
- Overall infection incidence was low (3%).
- Catheter duration was longer in infected patients (125 hours vs. 61 hours).
- Infection risk was negligible in the first 48 hours, rising to 6.2% thereafter, but poorly correlated with duration.
Conclusions:
- Arterial catheterization in children has a very low incidence of infection.
- Routine catheter reinsertion is not justified based on these findings.
Abstract:
To determine the incidence of infection secondary to arterial catheterization in children as well as the risk markers, we prospectively evaluated, during a 1-year period, all arterial catheters installed in children admitted to the pediatric intensive care unit. A total of 340 cannulas were placed in 310 children aged 80 +/- 4 months (mean +/- SEM) for a period of 64 +/- 4 hours. Most catheters were inserted percutaneously (99%) in the radial artery (86.5%). Ninety-two percent (313/340) of the catheters were sterile (group 1), 5% (17/340) were contaminated (less than 10 colony-forming units on semiquantitative culture) (group 2), and 3% (10/340) were considered either locally infected (ie, greater than or equal to 10 colony-forming units) (eight of 10) or associated with a possible catheter-related sepsis (two of 10) (group 3, or infected group). The incidence of local inflammation at the insertion site was higher in group 2 than in group 1 (18% vs 2.9%) but not statistically different between groups 3 and 1 (10% vs 2.9%). The duration of arterial catheterization was longer in group 3 than in group 1 (125 +/- 31 vs 61 +/- 4 hours). The risk of infection was nonexistent in the first 48 hours of catheterization. Thereafter it was calculated as being 6.2% (10/161), but it correlated poorly with the duration of arterial catheterization. These results confirm the very low incidence of infection related to arterial catheterization in children. Thus, routine catheter reinsertion is, in our opinion, unjustified.