Prospective Incidence Study of Bloodstream Infection in Infants and Children With Central Venous Catheters After Cardiac Surgery in Italy

Bezzio, Stefania; Scolfaro, Carlo; Broglia, R.; Calabrese, R.; Mignone, F; Abruzzese, P.; Aidala, Enrico; Valori, Andrea; Grassitelli, Sergio; Rizzo, Alberta; Iannandrea, S.; Tovo, Pier-Angelo

doi:10.1086/598242

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…Comparisons between umbilical catheters, PICCs, tunneled CVADs, and nontunneled CVADs based on dwell time, occlusion, thrombosis, and infection risk were the primary focus of the included studies. 15,31,35,88 Generally, short-term peripheral and nonperipheral compatible therapy delivered via umbilical catheters in infants can be used. 66 PICCs were recommended for patients with congenital cardiac conditions requiring $7 days of IV therapy.…”

Section: Congenital Cardiac Conditionsmentioning

confidence: 99%

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Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-tovein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients. WHAT'S KNOWN ON THIS SUBJECT: Individual studies, systematic reviews, and focused clinical practice guidelines that evaluate vascular access devices (VADs) in various pediatric populations are available. However, to date, no systematic review examining the appropriateness, and inappropriateness, of VADs across common pediatric clinical scenarios exists. WHAT THIS STUDY ADDS: There is strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures are poorly evidenced, necessitating the application of clinical judgment for VAD decision-making.

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Section: Congenital Cardiac Conditionsmentioning

confidence: 99%

“…136 CVAD (tunneled and nontunneled) use was reported in this population; however, placement $7 days was associated with an increased risk of CLABSI. 31,56 None of the included studies or guidelines included evidence to support the use of totally implantable venous devices in this population.…”

Section: Congenital Cardiac Conditionsmentioning

confidence: 99%

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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“…These data also were not included in the review. We were unable to ascertain the number of catheter days in 23 studies, [66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82]84,85,92,97,99,122 which excluded their data from contributing to the meta-analysis reporting failure and complications per 1000 catheter days. Because of a lack of data, the rate of CVAD failure per 1000 catheter days for nontunneled, percutaneous CVADs could not be estimated.…”

Section: Study Qualitiesmentioning

confidence: 99%

Complications of Central Venous Access Devices: A Systematic Review

et al. 2015

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CONTEXT: The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources.OBJECTIVE: To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics.DATA SOURCES: Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015.STUDY SELECTION: Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage. CONCLUSIONS: CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.

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“…A study done in Naples on 120 oncologic children found a positivity of blood cultures from central line in about one third (28.3%; 128/425 samples) of cases clinically suspected for infection [11]. There are two prospective studies performed in Turin: the first included 748 oncologic or immunologic patients within 7 years, registering 174 episodes of CLABSI [12], whereas the second enrolled 153 children with previous cardio-surgery, founding a CLABSI incidence of 11.7/1000 central line-days [13]. The only point-prevalence survey available in the Italian pediatric population was set in a large tertiary care children’s hospital in Rome between 2007 and 2010.…”

Section: Introductionmentioning

confidence: 99%

Central-line associated bloodstream infections in a tertiary care children’s University hospital: a prospective study

et al. 2016

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BackgroundThe central-line associated bloodstream infections (CLABSI) are the most common healthcare-associated infections in childhood. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. The present survey is the first prospective study monitoring for 6 months the occurrence of central-line associated bloodstream infections in all departments of an Italian tertiary care children’s university hospital.MethodsThe study involved all children aged less than 18 years admitted to Meyer Children’s University Hospital, Florence, Italy who had a central line access between the October 15th, 2014 and the April 14th, 2015. CLABSI were defined according to the Center for Disease Control and Prevention criteria. CLABSI incidence rates with 95% confidence limits were calculated and stratified for the study variables. For each factor the relative risk and 95% confidence intervals were evaluated. Statistical analysis was performed using the statistical software SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL), p < 0.05 was considered statistically significant.ResultsCLABSI rate was 3.73/1000 (95% CI: 2.54–5.28) central line-days. A higher CLABSI incidence was seen with female gender (p = 0.045) and underlying medical conditions (excepting prematurity, surgical diseases and malignancy) (p = 0.06). In our study 5 infections, were caused by extended-spectrum β-lactamase producing organisms and in one case by carbapenem-resistant Klebsiella pneumoniae.ConclusionsOur study confirms the spreading of multi-resistant pathogens as causes of healthcare associated infections in children. An increased incidence rate of CLABSI in our study was related to underlying medical conditions. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas.

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Prospective Incidence Study of Bloodstream Infection in Infants and Children With Central Venous Catheters After Cardiac Surgery in Italy

Cited by 9 publications

References 8 publications

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

Complications of Central Venous Access Devices: A Systematic Review

Central-line associated bloodstream infections in a tertiary care children’s University hospital: a prospective study

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