CENTRAL VENOUS CATHETER BLOOD-STREAM INFECTIONS IN THE NEONATAL INTENSIVE-CARE UNIT

Purpose: The goal of this study was to identify symptoms and signs rel ated to central venous catheter (CVC) bloodstream infections (BSI) in neonatal intensive care unit (NICU) patients that would predict infect ion and to identify factors that might influence CVC longevity. Method s: This was a retrospective cohort study evaluating 268 lines represen ting a total of 5,212 CVC days placed in 157 NICU patients over 29 mon ths by the pediatric surgery and neonatology services at one children' s hospital. Centers for Disease Control (CDC) criteria were used to de termine laboratory-confirmed BSI, Data were analyzed by univariate met hods and logistic regression and determined significant at the P less than .05 level. Results: Sixty-five lines (24%) from 54 patients had c onfirmed CVC BSI. Fever (49%) and pulmonary dysfunction (30%) were the most common symptoms of CVC BSI. Erythema or purulent discharge at th e insertion site was found in only 20% of cases. Staphylococcus epider midis was the most com mon organism isolated. Factors that significant ly decreased the incidence of CVC BSI were increasing estimated gestat ional age (EGA; P < .0013) at ti me of insertion, associated vancomyci n use at the time of catheter placement (P < .0057), and fewer days of catheter use (P < .0291), There were no significant differences noted caused by line location or catheter type. Conclusion: Fever and pulmo nary dysfunction were the most common signs of CVC BSI in neonates. Lo wer EGA and increased catheter du ration were significantly correlated with infection. The use of vancomycin concurrent with catheter insert ion was associated with a decreased incidence of CVC BSI, however conc erns regarding the emergence of vancomycin-resistant organisms preclud e support of its use as a prophylactic agent. Copyright (C) 1998 by W. B. Saunders Company.