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Published on: February 9, 2011
Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience
Rudrashish Haldar1, Ankur Mandelia2, Prabhaker Mishra3
1Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
This study found higher rates of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients. Younger age, longer CVC dwell time, and femoral catheterization were identified as key risk factors for CRBSIs.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Medical Device Infections
Background:
- Central venous catheters (CVCs) are crucial in pediatric surgical care but pose risks for colonization and infection.
- Catheter-related bloodstream infections (CRBSIs) are serious complications in pediatric patients, necessitating investigation into their incidence and risk factors.
Purpose of the Study:
- To determine the incidence of CVC colonization and CRBSIs in pediatric surgical patients.
- To identify independent risk factors associated with CVC colonization and CRBSIs in this population.
Main Methods:
- Retrospective review of electronic medical records for 260 pediatric surgical patients with CVC insertion.
- Data collection included demographics, CVC details, dwell time, site, colonization, CRBSI, and causative organisms.
- Statistical analysis to identify significant risk factors for CVC colonization and CRBSI.
Main Results:
- The rates were 32.8 per 1,000 catheter days for CVC colonization (19.6%) and 17.4 per 1,000 catheter days for CRBSI (10.4%).
- Younger age (<1 year), longer CVC dwell time, and femoral catheterization were significantly associated with higher rates of CVC colonization and CRBSI.
- Coagulase-negative staphylococcus was the most common organism isolated. Independent risk factors for CRBSI included younger age, increased CVC dwell time, and femoral CVC use.
Conclusions:
- The study highlights significant rates of CVC colonization and CRBSI in pediatric surgical patients, exceeding some previously reported Western literature rates.
- Younger age, prolonged CVC dwell time, and femoral catheterization are critical risk factors for CRBSI in this cohort.
- Strict adherence to CVC insertion/maintenance protocols and care bundles is recommended to mitigate infectious complications.
Abstract:
The purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age ( p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5-8] days) and CRBSI (6 [5-9] days) patients ( p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization ( p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.
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