Catheter-Related Infection and Pathogens of Umbilical Venous Catheterization in a Neonatal Intensive Care Unit in China

Abstract

We studied the incidence of umbilical venous catheterization (UVC)-related infection and pathogens in a neonatal intensive care unit (NICU) in China. Patients were grouped into <2000-g UVC or <2000-g non-UVC groups or ≥2001-g UVC or ≥2001-g non-UVC groups. Blood culture and umbilical root skin swab culture were taken following UVC insertion and extraction. UVCs were removed after 7 days and cultures of UVC tips were performed then. A total of 516 patients were enrolled. The incidence of UVC-related septicemia was 9.5%. The incidence of UVC-related septicemia per 1000 UVC days was 13.6. No significant difference was noted between <2000-g UVC and <2000-g non-UVC groups and between ≥2001-g UVC group and ≥2001-g non-UVC groups, in the number of positive blood cultures and skin cultures, the percentage of catheter-related septicemia, the incidence of catheter-related septicemia per 1000 catheter days, and the increase in the number of positive cultures between two skin cultures following UVC insertion and extraction. The predominant pathogen in all cultures was gram-positive pathogens. Coagulase-negative Staphylococcus was the most frequently noted pathogen. UVC did not increase the incidence of catheter-related infection in the NICU. It is necessary to consider local pathogen spectrum when choosing antibiotic therapy before specific culture results become available.

A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore

“…(11) Another study from China in 2012 yielded a rate of 13.6 per 1,000 umbilical catheter days. (12) The Canadian Neonatal Network UVC-associated CABSI rate seemed to have stayed stable at around 7.8-8.2 per 1,000 catheter days in another review published in 2015, (9) as part of a comparison with the peripherally inserted central catheter (PICC) line.…”

“…A retrospective cohort study that evaluated the outcome of introducing a standardised PICC and care bundle showed that infants with UVC lasting over seven days had a greater risk of central line-associated bloodstream infection (odds ratio 5.48) than those with UVC lasting seven days or less. (19) However, a recent Cochrane review by Gordon et al (3) that investigated early planned removal of UVCs within two weeks to prevent infection included only one studythat by O'Hara et al (12)(13)(14) CI 0.01-7.94). More infants in the early planned removal group than in the expectant management group required percutaneous insertion of a central catheter (or PICC).…”

Incidence and Determinants of Health Care-Associated Blood Stream Infection at a Neonatal Intensive Care Unit in Ujjain, India: A Prospective Cohort Study

“…Previous studies have shown that a very low birth weight and a longer duration of antibiotic therapy were risk factors for umbilical arterial catheter-related sepsis [ 32 ]. A study from China showed that the incidence of umbilical venous catherization related septicemia was at 9.5% [ 33 ]. The most common organisms associated with umbilical catheterization related septicemia in our study were Staphylococcus aureus and coagulase-negative Staphylococcus, which is similar to what was reported by previous studies [ 32 , 33 ].…”

Neonatal–perinatal medicine in a transitional period in China

“…As outbreak of severe sepsis is one of the most compelling challenges in SCNs of different regions, standardised neonatal ward management to prevent nosocomial infections is now mandatory and becoming a routine measure which requires well-controlled sterilisation facilities, hand hygiene, isolation space, restricted use of antibiotics, among other things, implemented as part of the hospital quality assurance. Umbilical vascular-accessed and peripheral-inserted central catheterisation are being more and more used for VLBW infants with restricted length of indwelling to prevent nosocomial infection in SCNs 34. Other pathogen-related infections are also encountered in daily service, ranging from hepatitis B virus35 and HIV, to mycoplasma, chlamydia and syphillis 36.…”