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Published on: July 13, 2019
Use of impregnated catheters to decrease colonization rates in neonates - A randomized controlled pilot trial
M Klemme1, A Staffler2, N De Maio1
1Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany.
Insights
Antibiotic and antimycotic impregnated peripherally inserted central catheters (PICC) tended to reduce colonization in neonates, but the difference was not statistically significant. Lower gestational age and male sex were identified as risk factors for catheter colonization.
Area of Science:
- Neonatal intensive care
- Infectious diseases
- Medical device technology
Background:
- Nosocomial infections pose significant risks to preterm infants, increasing mortality and morbidity.
- Central venous catheter colonization is a primary risk factor for these infections.
- While impregnated catheters show promise in adults and older children, their efficacy in neonates remains under investigation.
Purpose of the Study:
- To evaluate the impact of antibiotic and antimycotic impregnated peripherally inserted central catheters (PICC) on catheter colonization rates in preterm and sick term infants.
- To assess the incidence of catheter-associated infections with standard versus impregnated PICC-lines.
Main Methods:
- A randomized controlled trial involving neonates assigned to either standard (S-PICC) or impregnated (IP-PICC) PICC-lines.
- Catheter colonization was assessed using roll-out cultures, with >15 colony-forming-units/ml defining colonization.
- Outcomes included colonization rates, catheter-related local infections (CRI), and catheter-related systemic infections (CR-SI).
Main Results:
- Catheter colonization rates were lower in the IP-PICC group (5.6%) compared to the S-PICC group (12.1%), though this difference was not statistically significant (p=0.42).
- No significant differences were observed in CRI (2.9% vs. 6.1%; p=0.60) or CR-SI (0% vs. 3.1%; p=0.48) between the groups.
- Lower gestational age (median 25 4/7 weeks) and male sex were significantly associated with catheter colonization (p=0.01).
Conclusions:
- The use of antibiotic and antimycotic impregnated PICC-lines in neonates showed a trend towards reduced colonization but did not reach statistical significance.
- Lower gestational age and male sex are confirmed as significant risk factors for PICC colonization in this population.
- Further research may be needed to confirm the clinical utility of impregnated PICC-lines in neonates.
Objective:
Nosocomial infections increase mortality and morbidity in preterm infants. Central venous line colonization is a major risk factor for the development of such infections. In adults and children, antibiotic and antimycotic impregnated catheters have been demonstrated to reduce colonization. However, recently published data showed no significant difference in bloodstream infection in neonates when an impregnated catheter was used. We investigated the effect of impregnation of percutaneously inserted micro-catheters (PICC) on colonization in preterm and sick term infants in our unit.
Methods:
Neonates were randomly assigned to receive either a standard (S-PICC; n = 34) or antibiotic and antimycotic impregnated (IP-PICC; n = 37) PICC. Catheters were placed and removed according to a standard procedure and subsequently examined by roll-out culture. The primary outcome was the rate of colonization defined as >15 colony-forming-units/ml. Additional outcomes were catheter associated or systemic infections.
Results:
The rate of colonization was lower in neonates who received an IP-PICC as compared to S-PICC (5.6% vs. 12.1% respectively; p = 0.42). However, the difference was not significant. In IP-PICC vs S-PICC, catheter related local infection (CRI) although lower was not statistically significant (2.9% vs. 6.1%; p = 0.60). We observed no difference in catheter related systemic infection (CR-SI) (0% vs. 3.1%, p = 0.48). The neonates whose catheters were colonized were predominantly of a lower gestational age (median 254/7, p = 0.05) and males (100%, p = 0.01). In addition, the median colony count in the colonized IP-PICC catheters was lower as compared to S- PICC group (53 vs 250, p = 0.06).
Conclusions:
The use of antibiotic and antimycotic impregnated PICC-lines in neonates tended to decrease colonization rates in neonates in our centers but this difference was not significant. Lower gestational age and male sex are risk factors for catheter colonization.
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