Targeting Risk Factors for the Control of Central Line-Associated Bloodstream Infection in the Neonatal Intensive Care Unit: A Single Tertiary Center Experience
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Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU). Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed. Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P= 0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004). Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.
Abstract
Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU). Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed. Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P= 0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004). Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.
참고문헌 (35)
- Saint S, "The clinical and economic consequences of nosocomial central venous catheter-related infection : are antimicrobial catheters useful", Infect Control Hosp Epidemiol, 21, pp.375~380 (2000)
- Payne NR, "Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants", Pediatrics, 114, pp.348~355 (2004)
- 유선미, "Interventions to Prevent Catheter-Associated Bloodstream Infections: A Multicenter Study in Korea", Infection and Chemotherapy, 42(4), pp.216~222 (2010), 대한감염학회
- Wylie MC, "Risk factors for central line-associated bloodstream infection in pediatric intensive care units", Infect Control Hosp Epidemiol, 31, pp.1049~1056 (2010)
- O’Grady NP, "Guidelines for the prevention of intravascular catheter-related infections", Clin Infect Dis, 52, pp.e162~e193 (2011)
- Mannan K, "Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant", Acta Paediatr, 96, pp.1536~1537 (2007)
- Horbar JD, "NIC", Q 2000. NIC, Pediatrics, pp.2003, 111(4 Pt 2)[DOI]
- Dahan M, "CLABSI risk factors in the NICU: potential for prevention:a PICNIC study", Infect Control Hosp Epidemiol, 37, pp.1446~1452 (2016)
- Richardson DK, "SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores", J Pediatr, 138, pp.92~100 (2001)
- Liang SY, "Update on emerging infections: news from the Centers for Disease Control and Prevention. Vital signs:central line-associated blood stream infections: United States, 2001, 2008, and 2009", Ann Emerg Med, 58, pp.447~451 (2011)
- Coleman AJ, "First 24-h SNAP-II score and highest PaCO2 predict the need for ECMO in congenital diaphragmatic hernia", J Pediatr Surg, 48, pp.2214~2218 (2013)
- 성세인, "The Impact of Surgical Intervention on Neurodevelopmental Outcomes in Very Low Birth Weight Infants: a Nationwide Cohort Study in Korea", Journal of Korean Medical Science, 34(43), pp.1~10 (2019), 대한의학회
- Polin RA, "Epidemiology and diagnosis of health care-associated infections in the NICU", Pediatrics, 129, pp.e1104~9 (2012)
- Seckold T, "A comparison of silicone and polyurethane PICC lines and postinsertion complication rates : a systematic review", J Vasc Access, 16, pp.167~177 (2015)
- Garland SM, "The ProPrems trial : investigating the effects of probiotics on late onset sepsis in very preterm infants", BMC Infect Dis, 11, pp.210~ (2011)
- Jumani K, "Risk factors for peripherally inserted central venous catheter complications in children", JAMA Pediatr, 167, pp.429~435 (2013)
- Sengupta A, "Catheter duration and risk of CLA-BSI in neonates with PICCs", Pediatrics, 125, pp.648~653 (2010)
- Ohki Y, "Complications of peripherally inserted central venous catheter in Japanese neonatal intensive care units", Pediatr Int, 55, pp.185~189 (2013)
- Milstone AM, "Do prolonged peripherally inserted central venous catheter dwell times increase the risk of bloodstream infection", Infect Control Hosp Epidemiol, 31, pp.1184~1187 (2010)
- Milstone AM, "Catheter dwell time and CLABSIs in neonates with PICCs : a multicenter cohort study", Pediatrics, 132, pp.e1609~e1615 (2013)
- Ainsworth SB, "Peripherally inserted central catheters vs peripheral cannulas for delivering parenteral nutrition in neonates", JAMA, 315, pp.2612~2613 (2016)
- de Lutio E, "Peripherally inserted central venous catheters", pp.7~19 (2014), Springer
- Wildgruber M, "Polyurethane versus silicone catheters for central venous port devices implanted at the forearm", Eur J Cancer, 59, pp.113~124 (2016)
- Rudin C, "A comparative study of two different percutaneous venous catheters in newborn infants", Eur J Pediatr, 150, pp.119~124 (1990)
- Smirk C, "Neonatal percutaneous central venous lines : fit to burst", Arch Dis Child Fetal Neonatal Ed, 94, pp.F298~F300 (2009)
- Pezzati M, "Central venous catheters and cardiac tamponade in preterm infants", Intensive Care Med, 30, pp.2253~2256 (2004)
- Nair V, "Probiotics and prebiotics : role in prevention of nosocomial sepsis in preterm infants", Int J Pediatr, 2013, pp.874726~ (2013)
- Jacobs SE, "Probiotic effects on late-onset sepsis in very preterm infants : a randomized controlled trial", Pediatrics, 132, pp.1055~1062 (2013)
- Sharif S, "Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants", Cochrane Database Syst Rev, 10, pp.CD005496~ (2020)
- Athalye-Jape G, "Benefits of probiotics on enteral nutrition in preterm neonates : a systematic review", Am J Clin Nutr, 100, pp.1508~1519 (2014)
- Rao SC, "Probiotic supplementation and late-onset sepsis in preterm infants : a meta-analysis", Pediatrics, 137, pp.e20153684~ (2016)
- 고준영, "소아청소년에서 발생한 유산균 제제에 포함된 균주에 의한 침습성 감염증의 후향적 분석", Pediatric Infection and Vaccine, 24(3), pp.168~177 (2017), 대한소아감염학회[DOI]
- Zbinden A, "Case series of Bifidobacterium longum bacteremia in three preterm infants on probiotic therapy", Neonatology, 107, pp.56~59 (2015)
- 김세연, "Influence of Routine Probiotic Supplementation on the Incidence of Necrotizing Enterocolitis and Late Onset Sepsis", Neonatal medicine, 23(2), pp.88~94 (2016), 대한신생아학회
- Dudeck MA, "National Healthcare Safety Network report, data summary for 2013, device-associated module", Am J Infect Control, 43, pp.206~221 (2015)
