Rates of catheter-associated bloodstream infections among preterm newborns did not differ based on the use of peripherally inserted central catheters versus umbilical venous catheters, according to a study published online in Pediatrics.
“To clarify which mode of primary access is better for reducing CABSI [catheter-associated bloodstream infection] as well as other short- and long-term complications, a well-designed, adequately powered, randomized clinical trial will be needed,” wrote Dr. Mohamed Shalabi of Mount Sinai Hospital in Toronto and his associates (Pediatrics. 2015 Nov 16;136[6]:1073-9. doi: 10.1542/peds.2015-2710).
The researchers retrospectively compared the rates of CABSI among 540 infants born before 30 weeks’ gestation and admitted to neonatal units in the Canadian Neonatal Network between January 2010 and December 2013.
Three groups were compared: 180 infants who received a peripherally inserted central catheter (PICC) on their first day after birth; 180 infants, matched to the PICC group by gestational age, birth weight, and sex, who received an umbilical venous catheter (UVC) on their first day after birth; and 180 infants similarly matched to the PICC group who first received a UVC that was then changed to a PICC after at least 4 days.
The UVC + PICC group had the longest total catheter duration with 4,515 catheter days, compared with 3,012 days in the PICC group and 1,532 days in the UVC group. In the PICC group, the 37 infections translated to a rate of 9.3 infants with CABSI per 1,000 catheter days, compared with 12 CABSI episodes at a rate of 7.8 infants with CABSI per 1,000 catheter days in the UVC group. The UVC + PICC group’s 45 infections meant a rate of 8.2 infants with CABSI infections per 1,000 catheter days, resulting in no significant difference among the three groups’ CABSI rates (P greater than .05).
“Multivariate analyses revealed a higher incidence of infants with LOS [length of stay] per 1,000 catheter days in the PICC group versus the UVC + PICC group; however, this may be reflective of total catheter days,” the researchers reported. The lowest rate of late-onset sepsis, 12%, was in the UVC group, compared with 22% in the PICC group and 23% in the UVC + PICC group.
“Despite an equal number of patients in each group, the catheter days were significantly higher in both the PICC groups, compared with the UVC alone group,” Dr. Shalabi’s team reported. “This is probably a reflection of the clinical practice of removing UVCs by 5-7 days after birth, whereas PICCs are removed mostly when not needed or when complications occur.”
The analysis is limited by a lack of information regarding the reasons for use of one catheter over another and the fact that some patients had multiple infections while the PICC remained. “This reflects practice variations because in some cases a PICC is not removed after the first episode of infection and we do not have data on the reasoning behind such an occurrence,” the authors wrote.
The authors reported no relevant financial disclosures. The research did not receive explicit external funding, but the program and researchers receive some support from the Canadian Institutes of Health Research.