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Published on: July 13, 2019
Risk factors for early infection of central venous catheters in pediatric patients
D B Shaul1, B Scheer, S Rokhsar
1Department of Surgery, Childrens Hospital Los Angeles, University of Southern California, School of Medicine, 90027, USA.
Insights
Pediatric central venous catheter (CVC) infections are linked to neutropenia and lack of prophylactic antibiotics. Postponing CVC placement until absolute neutrophil count (ANC) exceeds 1,000 and administering perioperative antibiotics can reduce early CVC infections.
Area of Science:
- Pediatric critical care
- Infectious disease epidemiology
- Vascular access devices
Background:
- Central venous catheters (CVCs) are essential for pediatric patients but prone to infections.
- CVC infections can necessitate premature removal, impacting treatment.
- Identifying risk factors for early CVC infections is crucial for patient outcomes.
Purpose of the Study:
- To review host factors and surgical techniques associated with early CVC infections in pediatric patients.
- To identify specific risk factors contributing to CVC-related infections.
- To inform strategies for preventing premature CVC removal due to infection.
Main Methods:
- A case-control study identified pediatric patients with CVCs over 17 months.
- Early infection was defined by fever and positive blood cultures within 45 days of CVC placement.
- Factors analyzed included neutropenia (absolute neutrophil count [ANC]), perioperative antibiotics, fever, diagnosis, CVC site, and type.
Main Results:
- 12% of 473 CVCs resulted in early infections.
- Neutropenia (ANC < 1,000) was a significant risk factor (OR = 5.30, p = 0.004).
- Failure to administer perioperative antibiotics increased infection risk (OR = 0.42, p = 0.02).
Conclusions:
- Neutropenia and lack of prophylactic antibiotics are key risk factors for early CVC infections in pediatric patients.
- Recommendations include postponing CVC placement until ANC > 1,000 and administering perioperative antibiotics.
- Preoperative fever showed a trend toward higher infection rates.
Background:
In an effort to avoid infections that can lead to the premature removal of indwelling central venous catheters (CVCs), the surgical technique and host factors present in pediatric recipients of permanent CVCs were reviewed.
Study Design:
All patients receiving CVCs over a 17-month period were identified. Those patients with fever and positive blood cultures drawn through the CVC within 45 days of line placement were labeled as having early infection. A case-control design was used to select two control patients for each infected patient. Charts from both the infection and control groups were reviewed for several factors present at the time of CVC placement, including fever, neutropenia (absolute neutrophil count [ANC] < 500 and ANC < 1,000), use of perioperative antibiotics, diagnosis, CVC site, and type of CVC. Chi-square test with Yates correction was used to compare the groups. Odds ratios (ORs) and 95% confidence intervals were derived.
Results:
Among the 473 CVCs placed, early infections developed in 53 patients (12%). The control group consisted of 106 patients. Neutropenia was present in 16 of 53 infected patients versus 8 of 106 controls (p = 0.004, OR = 5.30). Perioperative antibiotics were given to 25 of 53 infected patients versus 72 of 106 controls (p = 0.02, OR = 0.42). Fever was present in 12 of 53 infected patients versus 14 of 106 controls (p = 0.19, OR = 1.92). Factors that were equally prevalent between the groups and that did not appear to influence the CVC infection rate included a diagnosis of malignancy, CVC type, and site of placement. Of the 53 infected catheters, 16 (30%) could not be cleared of infection and were removed.
Conclusions:
This study documents that neutropenia and failure to administer prophylactic antibiotics are risk factors for the development of early CVC infection in pediatric patients. To avoid early infection and possible premature CVC removal, we recommend that placement of permanent CVCs be postponed until the ANC is > 1,000. Perioperative antibiotics should be given. A trend toward higher infection rates was seen in patients with preoperative fever.
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