The Long-Term Effect of Antibiotic-Impregnated Catheters on Bloodstream Infection Rate in a PICU

BACKGROUND: Bloodstream infections are the most common reported healthcare-associated infections in pediatric facilities. To measure the effect, we compare catheter-related bloodstream infection (CR-BSI) rates for antibiotic-impregnated (rifampin/minocycline) catheters (AIC) to non-impregnated catheters (NAIC) in a PICU. Interventions such as the use of maximum barrier precautions (1998), handwashing compliance campaign (2000/2001), and chlorohexidine prep (2003) prior to catheter insertion also occurred. METHODS: Prospective, observational study conducted in a Pediatric Intensive Care Unit (PICU) of a childrenʹs hospital over 5-year period (1999–2003). CRBSI definitions are from National Nosocomial Surveillance System. Infection control professionals collected catheter days and reviewed medical record to determine if CR-BSI was present. The Intensivist determined type of catheter. Duration of catheterization, location of catheter, pediatric risk index (PRISM), and age of the patient were collected for analysis. RESULTS: The mean rate of CR-BSI in the study period has been 5.0/1000 (range = 3.8/1000–6.1/1000), which is significantly lower than the preceding 5-year period (mean 9.2, RANGE = 7.2/1000 − 9.7/1000) [{P=0.006]. The rate of CRBSI in AIC (4.6/1000) (range = 3.3 − 5.8/1000) is lower compared to NAIC (7.2/1000) (range = 5.4–9.1/1000) during this time period. This is in spite of the fact that AIC were placed for a longer duration (11 days versus 9 days), and placed in patients with higher mean PRISM scores (19.5 versus 13.3) and younger mean age (4 years versus 11 years) as compared to NAIC. CONCLUSION: The introduction of AIC has contributed significantly to a decline in the rate of CR-BSI in pediatric ICU patients.