Is central line repair associated with increased CLABSI rates

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Intravenous literature: Lundgren, I.S., Zhou, C., Malone, F.R., McAfee, N.G., Gantt, S. and Zerr, D.M. (2011) Central Venous Catheter Repair is Associated with an Increased Risk of Bacteremia and Central Line Associated Bloodstream Infection in Pediatric Patients. The Pediatric Infectious Disease Journal. 2011 Dec 2. [Epub ahead of print].

Abstract:

BACKGROUND.: Repair of broken central venous catheters (CVCs) is common in pediatric patients. We hypothesized that this practice predisposes to bacteremia and CVC-associated bloodstream infections (CLABSI).

METHODS.: We conducted a retrospective case-crossover study of pediatric patients aged 1 month to 21 years with CVC breakages who underwent a first-time repair at our institution, using repair kits provided by CVC manufacturers. We compared rates of bacteremia and CLABSI (defined by Centers for Disease Control and Prevention criteria) in the 30 days pre-repair (control period) and the 30 days post-repair (exposure period), with adjustment for within-patient correlation using conditional Poisson regression.

RESULTS.: The mean pre-repair rate of bacteremia was 9.9 per 1000 catheter days, which increased to 24.5 post-repair, resulting in an adjusted incidence rate ratio (IRR) of 1.87 (95% CI 1.05-3.33, p = 0.034). Risk of CLABSI demonstrated a greater than two-fold increase (IRR 2.15, 95% CI 1.02-4.53, p = 0.045) when all catheter days were included, and a four-fold increase when days on antibiotics were excluded (IRR 4.07, 95% CI 1.43-11.57, p = 0.008).

CONCLUSIONS.: We found that repair of a broken CVC was associated with a two to four-fold higher risk of developing CLABSI within 30 days of repair in pediatric patients. Further studies are needed to determine interventions to reduce this risk and to better define the relative merits of CVC repair compared with replacement in selected patient populations.

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