The Incidence Rate of Central Line-associated Blood Stream Infections Related to Peripherally Inserted Central Catheters and Its Related Factors in the Neonatal Intensive Care Units

Introduction: Preventing the incidence of central line-associated blood stream infections (CLABSI) related to peripherally inserted central catheters (PICCs) is a top priority in the neonatal intensive care units (NICUs), as it can reduce mortality, morbidity, and the length of hospitalization. Objective: The current study aims to identify factors related to CLABSI associated with PICC in Iranian infants hospitalized in the NICUs. Materials and Methods: This is a retrospective analytical study with a cross-sectional design. The medical records of 321 infants with PICC admitted to two NICUs of one maternal and neonatal hospital in Tehran, Iran, over 5 years (2018-2023) were reviewed, and their data were extracted using a researcher-made neonatal demographic/clinical checklist. Mann-Whitney U test and logistic regression analysis were used for data analysis. Results: Among 321 infants with PICC, 168(52.3%) were male and 153(47.6%) were female. Their mean birth weight was 1219.23±447.68 g, and their mean weight on the day of PICC insertion was 1215.72±454.81 g. The mean catheter dwell time was 15.97±10.45 days. The total days of hospitalization was 40.9±24.7. The incidence rate of CLABSI was 7.60 in 1000 catheters/days. The total days of hospitalization (P=0.007), duration of antibiotics therapy at the catheter dwell time (P=0.005), infant age on the day of reaching full enteral feeding (P=0.002), duration of mechanical ventilation at the catheter dwell time (P=0.007), cause of catheter removal (P=0.001), history of PICC insertion (P=0.003), catheter dwell time (P= 0.03)and duration of antibiotic therapy (P=0.005) were significantly different between infants with positive and negative blood culture tests for CLABSI. For every one day increase in the infant age on the day of reaching full enteral feeding, the risk of having a positive blood culture test for CLABSI increases by 0.06 units.  Conclusion: Several factors can influence the PICC-related CLABSI rate in infants. The infant age on the day of reaching full enteral feeding can predict the increased risk of having a positive blood culture test for CLABSI.