CLABSI variable by type of catheter and type of patient

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Intravenous literature: Wagner, M., Bonhoeffer, J., Erb, T.O., Glanzmann, R., Hacker, F.M., Paulussen, M., Weibel, D. and Heininger, U. (2011) Prospective study on central venous line associated bloodstream infections. Archives of Disease in Childhood. 96(9), p.827-31.

Abstract:

Objective – To prospectively assess the incidence rates and characteristics of central venous line associated bloodstream infections (CLABSI) in one institution.

Methods – All patients with indwelling central venous catheters (CVC) between 1 April 2008 and 31 March 2009 were enrolled. The medical records of patients were reviewed and information on relevant characteristics entered into a standardised questionnaire. Central laboratory records were regularly checked for positive blood cultures in study patients.

Results – There were 209 CVC for a total of 14752 CVC days in 152 patients (88 males, 58%) including neonates and patients with surgical conditions and haemato-oncological and other underlying diseases. Median age at CVC insertion was 3 months (IQR 0-56 months). Fourteen CLABSI occurred in 13 patients. Overall CLABSI incidence (per 1000 CVC days) was 0.95 (9.71 for silastic percutaneous CVC, 7.65 for other CVC, 1.97 for Broviac, 0.18 for Port-a-cath). CVC remained in place for ≤14 days in 109 (52%) instances, 15-90 days in 45 (22%) instances and >90 days in 55 (26%) instances. The incidence of CLABSI in these three categories was 3.36, 4.36 and 0.47, respectively. Predominating cultured organisms were coagulase-negative staphylococci (N=3), S. aureus (N=3), and Enterococcus spp. (N=3).

Conclusions – CLABSI incidence varied by type of catheter and type of patient, with the highest risk in neonates (with silastic percutaneous CVC) and by far the lowest risk for Port-a-cath CVC. Prophylactic measures to reduce CLABSI should be tailored to individual types of catheters and patient characteristics.

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