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Volume 49, Number 2, April 2016

Increased frequency of peripheral venipunctures raises the risk of central-line associated bloodstream infection in neonates with peripherally inserted central venous catheters 

Hao-Yuan Cheng, Chun-Yi Lu, Li-Min Huang, Ping-Ing Lee, Jong-Min Chen, Luan-Yin Chang


Corresponding author:

Corresponding author. Luan-Yin Chang, Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Number 8, Chung-Shan South Road, Taipei 100, Taiwan. 


Background and purpose: 

Central-line associated bloodstream infection (CLA-BSI), which is mostly caused by coagulase-negative staphylococcus, is an important morbidity in neonatal intensive care units. Our study is aimed to identify the risk factors of CLA-BSI in neonates with peripherally inserted central venous catheters (PICCs).



A retrospective cohort study of neonatal intensive care unit patients with a PICC insertion between January 1, 2011 and December 31, 2012 was conducted. We performed univariate and multivariate analyses with a logistic regression model to investigate the risk factors and the association between increased frequency of peripheral venipunctures during PICC use and the risk of CLA-BSI while adjusting for other variables.



There were 123 neonates included in our study. Thirteen CLA-BSIs were recorded within the follow-up period. The incidence of PICC-associated CLA-BSI was 4.99 per 1000 catheter-days. There was no statistically significant association between the risk of CLA-BSI and gestational age, birth weight, chronological age, or other comorbidities. However, the odds of CLS-BSI increased to 12 times if the patient received six or more venipunctures within the period without concurrent antibiotic use [odds ratio (OR), 11.94; p < 0.001]. The OR of CLA-BSIs increased by 16% per venipuncture during PICC use (OR, 1.14; p = 0.003). 



During PICC use, increased frequency of venipunctures, especially when there was no concurrent antibiotic use, substantially raises the risk of CLA-BSI. By decreasing unnecessary venipunctures during PICC use, PICC-associated CLA-BSI and further morbidities and mortalities can be prevented. 


Key words:

bloodstream infection, catheter-related infection, neonatal intensive care unit, peripherally inserted central venous catheter