신생아중환자실에서 지방유제 교체간격에 따른 중심정맥관 관련 혈류 감염 발생률과 위험인자 분석
Effect of Fat Emulsion Hang Time Changes on Central Line-associated Bloodstream Infection Rates and Risk Factor Analysis in a Single Center Neonatal Intensive Care Unit
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Background : Intravenous fat emulsions (IVFE) can promote pathogenic organisms to proliferate. Therefore, many guidelines recommend changing intravenous infusion sets for IVFE administration every 24 or 12 hours. In this study, we evaluated the effect of IVFE hang time on central line-associated bloodstream infection (CLABSI) rates and analyzed risk factors of CLABSI in a single center neonatal intensive care unit (NICU). Methods : This is a retrospective study of NICU patients who were prescribed SMOFlipid 20% 100mL emulsion from 1 January 2017 to 30 June 2018. We divided the patients into two groups, based on IVFE hang time; 24 hours group (n=247) and 12 hours group (n=85). Results : Demographic characteristics were similar between the two groups; except birth weight. Duration of hospital stay and catheter dwell time was longer in the 24 hours group. There was no significant difference in CLABSI rate between the two groups (1.60 vs. 1.52 per 1,000 catheter days in the 24 hours vs. 12 hours groups). Risk factor analysis indicated that prolonged hospitalization (≥80 days, p=0.048), longer catheter dwell time (≥35 days, p=0.001), duration of IVFE (≥14 days, p=0.034) and duration of total parenteral nutrition (≥7 days, p=0.031) were statically significant in univariable analysis. On multivariable analysis, catheter dwell time (odds ratio 10.73; 95% confidential interval 1.695- 67.926; p=0.012) was independently associated with the occurrence of CLABSI. Conclusions : Shortening IVFE hang time from 24 hours to 12 hours did not alter CLABSI rate, and risk factor of CLABSI was catheter dwell time.
Abstract
Background : Intravenous fat emulsions (IVFE) can promote pathogenic organisms to proliferate. Therefore, many guidelines recommend changing intravenous infusion sets for IVFE administration every 24 or 12 hours. In this study, we evaluated the effect of IVFE hang time on central line-associated bloodstream infection (CLABSI) rates and analyzed risk factors of CLABSI in a single center neonatal intensive care unit (NICU). Methods : This is a retrospective study of NICU patients who were prescribed SMOFlipid 20% 100mL emulsion from 1 January 2017 to 30 June 2018. We divided the patients into two groups, based on IVFE hang time; 24 hours group (n=247) and 12 hours group (n=85). Results : Demographic characteristics were similar between the two groups; except birth weight. Duration of hospital stay and catheter dwell time was longer in the 24 hours group. There was no significant difference in CLABSI rate between the two groups (1.60 vs. 1.52 per 1,000 catheter days in the 24 hours vs. 12 hours groups). Risk factor analysis indicated that prolonged hospitalization (≥80 days, p=0.048), longer catheter dwell time (≥35 days, p=0.001), duration of IVFE (≥14 days, p=0.034) and duration of total parenteral nutrition (≥7 days, p=0.031) were statically significant in univariable analysis. On multivariable analysis, catheter dwell time (odds ratio 10.73; 95% confidential interval 1.695- 67.926; p=0.012) was independently associated with the occurrence of CLABSI. Conclusions : Shortening IVFE hang time from 24 hours to 12 hours did not alter CLABSI rate, and risk factor of CLABSI was catheter dwell time.
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