Abstract
Objective. Over 250,000 cases of central venous catheter-associated bloodstream infections (CVC-BSI) occur annually in the US leading to increased morbidity, costs, and mortality. While found to decrease the incidence of CVC-BSI in adult patients, no recommendations exist on the use of antimicrobial-impregnated catheters (AIC) in pediatric patients. This study was conducted to assess the effectiveness of AIC in reducing the incidence rates of CVC-BSI in a pediatric intensive care unit (PICU). Design. Retrospective cohort study. Setting. A 16-bed PICU in a tertiary children's hospital. Interventions and measurements. All PICU admissions requiring placement of a central venous catheter (CVC) from January 1999 through June 2003 were assessed for CVC-BSI, 21 months before, and 30 months after, introduction of AICs. Results. Of 5005 admissions during the 51-month study period, 1656 (33%) required CVC placement. Of these, 1441 (87%) admissions were initially assessed. Of these, 612 admissions (3057 CVC days) required CVC placement during the initial 21-month period while 829 admissions (4220 CVC days) required CVC placement during the subsequent 30-month period. The nosocomial CVC-BSI rates before and after the introduction of AICs were 7.85 CVC-BSI/1000 CVC days and 5.21 CVC-BSI/1000 CVC days, respectively (p=0.17). A sub-cohort of 647 (39%) admissions that required placement of a single CVC was subsequently analyzed. In the sub-cohort, 284 admissions (1269 CVC days) required CVC placement during the 21-month pre-AIC period, while 363 admissions (1458 CVC days) required CVC placement during the 30 months after introduction of AICs. The nosocomial CVC-BSI rates before and after the introduction of AICs were 3.15 CVC-BSI/1000 CVC days and 2.06 CVC-BSI/1000 CVC days, respectively (p=0.48). In multivariate regression analyses controlling for multiple risk factors for CVC-BSI, the use of AIC was not associated with statistically significant reduction in the rates of CVC-BSI among the entire cohort with multiple catheters (Incidence rate ratio = 1.04, 95% Confidence Interval: 0.93–1.15), or in the sub-cohort with single catheters (Incidence rate ratio = 0.91, 95% Confidence Interval: 0.78–1.06). Conclusions. Introduction of antimicrobial-impregnated catheters was associated with no significant reduction in nosocomial CVC-BSI rates in a cohort of critically ill children. Further adequately-powered prospective studies to address the effectiveness of AICs in reducing nosocomial CVC-BSI rates among cohorts of critically ill children are required.