The impact of central line-specific dwell-times for neonatal central line associated catheter infections:  A population-based descriptive analysis in Central Switzerland

The impact of central line-specific dwell-times for neonatal central line associated catheter infections: A population-based descriptive analysis in Central Switzerland | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The impact of central line-specific dwell-times for neonatal central line associated catheter infections: A population-based descriptive analysis in Central Switzerland Martina Buttera, Carolyn Luhmann-Lunt, Michael Buettcher, Lehnick Dirk, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6633395/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Sep, 2025 Read the published version in Antimicrobial Resistance & Infection Control → Version 1 posted 9 You are reading this latest preprint version Abstract Background Central line-associated bloodstream infections (CLABSIs) are among the most serious infectious complications associated with central lines in neonates. CLABSIs can be prevented by healthcare workers using "bundles" when inserting and managing central lines. These include prompt removal of the central line when it is no longer needed. The aim of this study was to describe and analyze neonatal CLABSIs, focusing on a minimal data set including specific catheter types and dwell times. Methods A retrospective descriptive study reviewing the management and outcome of neonates with CLABSI admitted to the Department of Neonatology and Neonatal Intensive Care at the Children's Hospital of Central Switzerland in Lucerne from 1 January 2020 to 31 December 2023. Results In this four-year period, a total of 27,636 neonates were born in the catchment area and 2599 neonates (9.4%) were admitted to our hospital. In total, 615 neonates (23.7%) had at least one central line with a total of 4940 catheter days. We observed an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days. The rate varied significantly by catheter type: 0 per 1,000 catheter days for umbilical artery catheters (UACs), 0.9 per 1,000 catheter days for peripherally inserted central lines (PICCs), 5.6 per 1,000 catheter days for umbilical venous catheters (UVCs), and 17.9 per 1,000 catheter days for centrally inserted venous catheters (CVCs). All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days. Conclusions We observed a pronounced variation in CLABSI rates between different catheter types. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days, and the rate of CLABSI increased with longer dwell times for UVCs and CVCs. This suggests a reduction in dwell time as a potential strategy for future quality improvement programs aiming for a zero CLABSI rate and underlines the importance of reporting central-line specific dwell-times for future publications. CLABSI NICU central catheters umbilical catheters PICC-lines neonates dwell-time Figures Figure 1 Figure 2 Figure 3 Background It is widely recognized that the use of central catheters can expose neonates to a variety of complications. Immediate complications may include injury to nearby structures, phlebitis, air embolism, hematoma, arrhythmia and malposition. Later complications include infection, occlusion, thrombosis, infiltration, extravasation and catheter migration. [1–3] Central line-associated bloodstream infections (CLABSIs) are the most common and serious complication associated with the use of central catheters in neonates. CLABSIs are also the most common nosocomial infection, accounting for up to 50% of all hospital-acquired sepsis cases. [4–7] Between 5% and 30% of neonates with a central line will develop a bloodstream infection, leading to increased morbidity, mortality and healthcare costs. [8–14] Premature infants, particularly those with very low birth weight, are at higher risk of CLABSI due to their immature immune systems and the extensive use of central venous catheters for essential medical care. [15] Unlike other neonatal infections, CLABSIs are often preventable, and healthcare professionals should work continuously to improve central line management. In recent years, significant efforts have been made to identify effective preventive strategies, commonly referred to as 'bundles of care', to reduce CLABSI rates. A meta-analysis of 24 studies showed an average reduction in CLABSI rates of 60% following implementation of these bundles in neonatal intensive care units. [16] In clinical practice, these bundles need to be continuously reviewed and updated with the latest international guidelines to improve the quality of care. [17] Prompt removal of central lines when no longer needed is one of the most widely reported strategies for reducing the risk of CLABSI. [16,17] However, there is a lack of clear evidence in the neonatal literature on the maximum safe central line dwell time and the benefits of prophylactic removal or replacement. In addition, the risk of infection may vary depending on the type of central catheter used - such as umbilical venous catheters (UVCs), umbilical arterial catheters (UACs), peripherally inserted central catheters (PICCs) or centrally inserted venous catheters (CVCs) - suggesting that the maximum dwell time may be different for each. We hypothesize that in order to effectively reduce neonatal CLABSI rates, it is crucial to understand catheter-specific CLABSI rates. This requires analysis of both the types of catheters used and their dwell times. In this descriptive study, we will examine CLABSI cases focused on catheter type and dwell time over a four-year period in a Swiss neonatal intensive care unit (NICU). In addition, we aim to demonstrate the feasibility and potential benefits of a minimal CLABSI dataset as a basis for the development of effective future quality improvement programs. Methods We conducted a retrospective, single-center study of CLABSI cases in all neonates admitted to the Department of Neonatology and Pediatric Intensive Care at the Children's Hospital of Central Switzerland from 1 January 2020 to 31 December 2023. The Intensive Care Unit has 9 beds, and the Intermediate and Long-Term Care Unit has 29 beds. We are a level III referral center for central Switzerland with a neonatal surgical program that includes minimally invasive surgery. Our perinatal network links us to nine maternity units and we admit around 2,000 neonates per year. As there are no other children's hospitals or neonatal units in the region, all neonates requiring specialist care are transferred to our center. Although it is possible for neonates requiring highly specialized care to be transferred to tertiary centers outside central Switzerland, this only happens occasionally due to a lack of beds at our center. As a result, we can report data that are almost population based. Inclusion criteria and definitions We included in the study all newborns within 44 weeks of gestational age admitted to our NICU/Neonatology from 1 January 2020 to 31 December 2023. Each case with a positive blood culture was individually investigated to assess whether the infection was catheter-related or not. CLABSI was defined according to the latest CDC criteria as a laboratory-confirmed bloodstream infection (LCBI) in which an eligible bloodstream infection (BSI) pathogen is identified, and an eligible central line is present either on the day of the LCBI event or the day before. The CLABSI rate is defined as the total number of CLABSI divided by the total number of device days x 1000 [18]. We analyzed CLABSI associated with UVC, UAC, PICC and CVC. CVC included jugular, brachiocephalic and femoral central lines. Central line management and CLABSI prevention strategies During the study period, a UVC was used as the standard central catheter for all preterm infants born before 32 weeks' gestation and for all neonates requiring resuscitation or intubation in the delivery room or within the first 24 hours of life. A UAC was used as the standard catheter for all preterm infants born before 28 weeks' gestation and for all neonates requiring resuscitation, intubation or catecholamines in the delivery room or within the first 24 hours of life. PICCs were used as standard catheters for all neonates requiring central access after UVC removal. CVCs were used for neonates requiring surgery or in unstable conditions requiring intubation, resuscitation or catecholamines beyond the first few days of life. The standard operating procedure for CLABSI prevention remained unchanged throughout the study. The CLABSI bundle included strict aseptic protocols for central catheter insertion, hygiene guidelines for catheter care, and maximum dwell times of 7 days for UVC, UAC and PICC. The maximum dwell time for each central line could be extended by the treating physician in certain situations. There was no defined maximum dwell time for CVC. In cases of suspected late-onset sepsis (LOS), the standard operating procedure (SOP) recommended starting antibiotic therapy with amikacin and amoxicillin with clavulanic acid. This antibiotic regimen for LOS was determined regardless of the presence of a central line. Data collection In autumn 2019, the hospital implemented the new patient data management system from EPIC. The electronic medical records were used to assess the annual catheter days and the different types of catheters. For each patient, the following information was collected from the electronic database: sex, gestational age, birth weight, mode of delivery, history of congenital heart disease, NEC or hypothermia, and presence of a central catheter. For each central catheter inserted, we analyzed the type and median dwell time. From the microbiology database, we collected information on the microorganism identified in blood cultures, date of infection, antibiotic treatment, occurrence of CLABSI, and any CLABSI-related complications such as need for invasive ventilation, inotropic support, or mortality. The study was approved by the Regional Ethics Committee (EKNZ) and the need for an informed consent was waived by the EKNZ (Project ID: 2022–02209). Data were accessed by the data manager of the unit from March 1, 2024 until May 31, 2024. After the process of data access by the data manager, patient data were stored in a secure and anonymized database. All analyses by the author team were done using the anonymized database. The study fulfills the criteria of the STROBE checklist regarding cohort studies. Statistical analyses All data reported have been analyzed both overall the 4 years and annually. Descriptive data is presented as median and interquartiles [Q1, Q3] for continuous variables and as frequency (%) for categorical variables. The dwell-times by catheter were illustrated in a Box plot. CLABSI events were analyzed using a time-to-event analysis per catheter, including graphical displays of Kaplan-Meier estimates. Statistical analyses of dwell-times and the time-to-event analysis of CLABSI events were performed using StataNow (Version 18.5, StataCorp, College Station, Texas, USA). Results A total of 27,636 neonates were born in the catchment area between the beginning of 2020 and the end of 2023. Of this population, 2599 neonates (9.4%) were admitted to our hospital and 615 neonates (23.7%) had at least one central line. The annual data are summarized in Table 1 . When analyzing the specific central catheter type, PICC was used most frequently in 312 neonates (50.7%) with a total of 3423 catheter days (69.3% of all catheter days), followed by UVC in 167 neonates (27.2%) with 709 catheter days (14.4%) and UAC in 104 neonates (16.9%) with 411 catheter days (8.3%). CVC was used least in 32 neonates (5.2%) with 397 catheter days (8.0%) (Table 2 ). When analyzing the median dwell time of the different types of catheters, CVCs were left in place the longest ones with a median dwell-time of 10 days, followed by PICCs (6 days), UVCs (4 days) and UACs (3 days) (Fig. 1 ). Table 1 Basic characteristics of the population Year Live-born infants in the catchment area of Central Switzerland Newborns admitted to NICU/Neonatology (% live-born) Newborns with a central catheter (% admitted) Newborns with CLABSI episode (% with a central line 2020 7018 640 (9.1) 172 (26.8) 4 (2.3) 2021 7228 676 (9.4) 157 (23.2) 3 (1.9) 2022 6701 656 (9.8) 152 (23.2) 3 (2.0) 2023 6689 627 (9.4) 134 (21.4) 4 (3.0) 2020–2023 27636 2599 (9.4) 615 (23.7) 14 (2.3) NICU = Neonatal intensive care unit, CLABSI = central line associated blood stream infection Table 2 Catheter data and central line associated blood stream infection (CLABSI) rates 2020 2021 2022 2023 2020–2023 Number of patients with a central catheter: n 172 157 152 134 615 Number of patients with PICC: n (%) 76 (44.2) 80 (51) 79 (52) 77 (57.4) 312 (50.7) Number of patients with UVC: n (%) 54 (31.4) 43 (27.4) 41 (27) 29 (21.7) 167 (27.2) Number of patients with UAC: n (%) 30 (17.4) 26 (16.6) 27 (17.7) 21 (15.7) 104 (16.9) Number of patients with CVC: n (%) 12 (7) 8 (5) 5 (3.3) 7 (5.2) 32 (5.2) Total number of catheters: n 250 215 199 196 860 Number of PICC: n (%) 148 (59.2) 133 (61.9) 119 (59.8) 133 (67.9) 533 (62.0) Number of UVC: n (%) 56 (22.4) 45 (20.9) 45 (22.6) 30 (15.3) 176 (20.5) Number of UAC: n (%) 30 (12.2) 26 (12.1) 31 (15.6) 25 (12.8) 112 (13.0) Number of CVC: n (%) 16 (6.4) 11 (5.1) 4 (2.0) 8 (4.1) 39 (4.5) Dwell time of all catheter types in days: Median (IQR) 6 (3–8) 5 (3–8) 6 (3–8) 5 (3–8) 6 (3–8) Dwell time of PICC in days: Median (IQR) 6 (5–8) 7 (5–8) 6 (5–8) 6 (4–8) 6 (5–8) Dwell time of UVC in days: Median (IQR) 2.5 (1-6.5) 4 (2–6) 4 (1–7) 4 (2–5) 4 (2–6) Dwell time of UAC in days: Median (IQR) 3.5 (2–6) 3 (3–4) 3 (2–6) 2 (1–4) 3 (2–5) Dwell time of CVC in days: Median (IQR) 10.5 (5-13.3) 9 (1–12) 10 (5-11.5) 12 (7-17.5) 10 (4–13) Catheter days all together: n 1405 1326 1104 1105 4940 PICC days: n (%) 921 (65.6) 937 (70.7) 765 (69.3) 800 (72.4) 3423 (69.3) UVC days: n (%) 215 (15.3) 184 (13.9) 192 (17.4) 118 (10.7) 709 (14.4) UAC days: n (%) 119 (8.5) 100 (7.5) 114 (10.3) 78 (7 − 1) 411 (8.3) CVC days: n (%) 150 (10.7) 105 (7.9) 33 (3.0) 109 (9.9) 397 (8.0) CLABSI rate (all catheter types)/1000 catheter days 2.8 2.3 2.7 3.6 2.9 CLABSI rate (PICC)/1000 catheter days 2.2 1.1 0 0 0.9 CLABSI rate (UVC)/1000 catheter days 0 0 15.6 8.5 5.6 CLABSI rate (UAC)/1000 catheter days 0 0 0 0 0 CLABSI rate (CVC)/1000 catheter days 13.4 19.6 0 28.3 17.9 PICC = Peripherally inserted central line, UVC = umbilical venous catheter, UAC = umbilical arterial catheter, CVC = centrally inserted venous catheter, IQR = interquartile range A total of 14 cases of CLABSI were identified. The overall and annual CLABSI rates by catheter type are shown in Table 2 . The observed overall CLABSI rate was 2.9/1000 catheter days, lowest for PICC (0.9/1000 catheter days) and highest for CVC (17.9/1000 catheter days). Annual data are highly variable. The time-to-event curves show that there were no cases of CLABSI within the first 5 days of dwell time (Fig. 2 ). After nine days, the rate of CLABSI increases compared to the window between 6 and 9 days. When comparing the different catheter types, the time-to-event curves of UVC and CVC show similar trends with increasing rates of CLABSI as the dwell time of the specific catheter increases. The PICC time-to-event curve remains more stable and there were no cases of CLABSI with UACs. UVC-associated CLABSIs were observed after a dwell time of 6 to 10 days, PICC-associated CLABSIs after 7 to 12 days and CVC-associated CLABSIs after 9 to 20 days (Fig. 2 ). Table 3 shows the main characteristics of the 14 cases of CLABSI, including the specific catheter responsible for the episode, the dwell time and the severity of the CLABSI cases, defined as the need for mechanical ventilation or inotropes or death related to the infection. Two of the 14 cases were classified as severe CLABSI. The first patient with severe CLABSI required mechanical ventilation within 48 hours of blood culture collection, despite appropriate empirical treatment. The second case had an underlying genetic disorder, which was confirmed during the CLABSI episode, and after discussion with the parents, the child was transferred to palliative care and died. Table 3 Detailed description of all central line associated blood stream infection (CLABSI) episodes Year GA at positive Blood culture (weeks) Age at positive Blood culture (days) Main diagnosis Associated Catheter type Catheter dwell time until CLABSI (days) Microorganism identified Adequate antibiotic treatment CLABSI severity Mechanical ventilation Inotrope medications Death 2020 29 29 Prematurity, severe BPD PICC 7 Staphylococcus Capitis Yes No No No 2020 37 86 NEC CVC (femoral) 13 Staphylococcus Aureus Yes No No No 2020 25 9 Prematurity, acute kidney failure PICC 8 Staphylococcus Capitis, Staphylococcus Epidermidis Yes No No No 2020 40 12 congenital diaphragmatic hernia CVC (jugular) 9 Staphylococcus Epidermidis No No No No 2021 26 18 Prematurity, bilateral renal vein thrombosis PICC 12 Staphylococcus Aureus Yes No No No 2021 40 113 NEC CVC (jugular) 10 Staphylococcus Aureus Yes No No No 2021 40 83 NEC, ultra-short bowel syndrome CVC (jugular) 6 Enterobacter Cloacae Yes No No No 2022 28 7 Prematurity, meningitis UVC 7 Pseudomonas Aeruginosa No No No No 2022 31 6 Prematurity, meningitis, endocarditis UVC 6 Staphylococcus Aureus Yes No No No 2022 31 7 Prematurity UVC 7 Staphylococcus Epidermidis Yes No No No 2023 26 9 Prematurity, ROP UVC 9 Staphylococcus Aureus, Klebsiella Pneumoniae Yes Yes No No 2023 33 20 NEC, partial monosomy cr. 8, partial trisomy cr. 16 CVC (jugular) 9 Staphylococcus Epidermidis Yes No No No 2023 36 41 NEC, partial monosomy cr. 8, partial trisomy cr. 16 CVC (femoral) 19 Staphylococcus Epidermidis, Klebsiella Oxytoca Yes Yes Yes Yes 2023 37 18 Jejunal atresia CVC (brachiocephalic vein) 16 Staphylococcus Epidermidis No No No No PICC = Peripherally inserted central line, UVC = umbilical venous catheter, UAC = umbilical arterial catheter, CVC = centrally inserted venous catheter. NEC = necrotizing enterocolitis, ROP = retinopathy, BPD = bronchopulmonary dysplasia. Staphylococcus epidermidis , followed by Staphylococcus aureus and Staphylococcus capitis were the most common pathogens responsible for CLABSI. In 11 out of 14 neonates (78%), empirical antibiotic therapy was appropriate, with at least one antimicrobial agent effective against the pathogen. The most commonly used antibiotics for empirical treatment of CLABSIs were the combination of amikacin and amoxicillin with clavulanic acid. The three CLABSI cases with inappropriate primary antibiotic therapy were two cases of Staphylococcus epidermidis and one case of Pseudomonas aeruginosa . None of these were serious infections and all neonates recovered fully. Discussion In this four-year retrospective study, we observed an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days. The rate varied significantly by catheter type: 0 per 1,000 catheter days for UACs, 0.9 per 1,000 catheter days for PICCs, 5.6 per 1,000 catheter days for UVCs, and 17.9 per 1,000 catheter days for CVCs. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days. The rate of CLABSI increased with longer dwell times for UVCs and CVCs. In the literature, most studies on neonatal CLABSI focus on the risk of infection associated with umbilical catheters and PICC lines. [19–23] Although CVCs are less commonly used in neonates, the high CLABSI rate associated with CVCs in our cohort highlights the need to include CVCs in analyses of neonatal CLABSI. Our overall CLABSI rate of 2.9 per 1,000 catheter days is consistent with other studies and is among the lowest reported neonatal CLABSI rates. A systematic review published in 2013 reported neonatal CLABSI rates ranging from 3.2 to 21.8 per 1,000 catheter days [24]. A recent cohort study in the Netherlands evaluating CLABSI rates in nine neonatal centers found an incidence ranging from 2.9 to 16.1 per 1,000 catheter days [25]. A Danish study recently reported a neonatal CLABSI rate of 13.4 per 1,000 catheter days, and a longitudinal analysis over 10 years in a Dutch neonatal center found stable annual CLABSI rates with no trend between 8.8 and 25.3 per 1,000 catheter days [26, 27]. In our cohort, the CLABSI rate varied significantly by catheter type. PICCs, which were the most commonly used central catheters (accounting for 69% of all catheter days), had a low infection rate of 0.9 per 1,000 catheter days. Notably, in the second half of the study period (2022 and 2023), with 1,565 PICC days, no PICC-related CLABSI cases were detected. This is lower compared to the literature, where most studies report a PICC-related CLABSI rates above 1 per 1,000 catheter days over several years. [20, 23, 28] Conversely, CVCs were used less frequently in our cohort (8% of all catheter days), but they had the highest CLABSI incidence, at 17.9 per 1,000 catheter days. This increased risk associated with CVCs compared to PICCs has been documented in other studies. For example, a retrospective study at a neonatal center in Qatar reported CLABSI rates of 1.8 and 3.3 per 1,000 catheter days for PICCs in 2016 and 2017, respectively, compared to 6.9 and 14.3 per 1,000 catheter days for CVCs. [29] Another retrospective study of four pediatric intensive care units in Brazil found that CVCs had an increased risk of CLABSI compared with PICCs, with an adjusted hazard ratio of 2.20 (95% CI 1.05–4.61; p = 0.037). [30] Umbilical catheters, which are commonly used in the early life of neonates, accounted for 22.7% of all catheter days in our cohort. We observed no case of CLABSI associated with UACs, but a relatively high rate of UVC-associated CLABSI at 5.6 per 1,000 catheter days. This is somewhat at odds with the literature, which generally reports similar CLABSI rates for UVCs and UACs, although our UVC-associated CLABSI rate is consistent with some reports. [31, 32] The increased risk of CLABSI associated with UVCs compared to PICCs is consistent with the existing literature, while the lower risk of UVC-related CLABSI compared to CVCs is inconsistent with some studies. [33] In our cohort, CVCs had the longest median dwell time (10 days) and the highest CLABSI rate (17.6 per 1,000 catheter days). Conversely, PICCs had the second longest median dwell time (6 days) and the lowest CLABSI rate (0.9 per 1,000 catheter days). This suggests that the risk of CLABSI cannot be attributed to dwell time alone. However, no CLABSI events were observed within 5 days, with increasing rates after 9 days. The rate of CLABSI increased further with longer dwell times for UVCs and CVCs (Fig. 2 ). Therefore, the risk of CLABSI appears to be a function of catheter type and dwell time (Fig. 3 ). The literature on catheter-specific risk of CLABSI and dwell time is highly controversial. Some studies have found no significant differences in UVC-associated CLABSI rates up to 14 days, while others report a stepwise increase in risk after the first few days. [20, 27, 31, 32, 34] As a result, recommendations are inconsistent. A recent review of 177 articles on the maximum duration of UVCs and neonatal CLABSI concluded that there is insufficient strong evidence and broad consensus to replace UVCs after 14 days. The review cautiously suggested that replacing UVCs within 7 days may help prevent CLABSI. [35] The literature on PICCs is even more mixed. Some studies found no significant association between PICC dwell time and PICC-associated neonatal CLABSI rates, while others observed a statistically significant increase in CLABSI rates with dwell times of 8 to 13 days or more than 14 days compared with shorter dwell times. [20, 23, 27, 28] When analyzing the 14 cases of CLABSI in our cohort, we observed dwell times for the specific catheter type within the last two days or later of the expected maximum according to our SOP for the prevention of CLABSI. Due to the small number of CLABSI cases in our cohort, we cannot make statistical associations. However, with the goal of zero CLABSI rates, one potential strategy is to focus on minimizing the maximum length of stay. In our study, all four UVC-associated CLABSI cases occurred after 5 days, the three PICC-associated CLABSI cases after 7 days, and the CVC-associated CLABSI cases after 9 days. This suggests that setting and adhering to new catheter-specific maximum dwell times may be beneficial. However, without robust evidence from the literature on optimal dwell times, we must weigh the benefits against the risks of such a strategy. Reducing dwell times could lead to increased pain from more frequent punctures, increased radiation exposure, and potential complications from new central catheter insertions. [34] On the other hand, the recent introduction of procedural ultrasound has greatly assisted neonatologists in central catheter placement. This advance has reduced the number of attempts required, reduced radiation exposure and lowered the incidence of complications, making it an integral part of routine clinical practice. [36, 37, 38] In addition to catheter type and dwell time, clinical circumstances need to be taken into account. Although this is not possible for the entire cohort of patients with a central line, the observation of several neonates with CLABSI and intra-abdominal pathology (NEC, jejunal atresia, diaphragmatic hernia) suggests that this condition may be a specific risk for CLABSI (Table 3 ). This is consistent with the literature showing an increased risk of CLABSI in cases with intra-abdominal pathology. [39] Coagulase-negative staphylococci emerged as the most common pathogens involved in CLABSI pathogenesis due to their ability to colonize the skin and form biofilms on indwelling devices, as confirmed by several other studies [22, 23, 40, 41]. In 10 out of 14 CLABSI cases in our cohort (71%), staphylococci were the responsible pathogen. Of the 14 cases of CLABSI, only two were considered "severe": one in an extremely preterm patient with a UVC in place for 10 days and another in a patient with NEC and a genetic disorder who had a femoral CVC in place for 19 days. Both patients with severe CLABSI received appropriate empirical antibiotic treatment from the outset. It is important to note that we defined CLABSI cases on the basis of a single positive blood culture. A study comparing one versus two blood cultures in the diagnosis and management of coagulase-negative staphylococcal infections found an 8.2% higher detection rate with one versus two cultures. [42] Most neonatal units use the single blood culture strategy because of the limited blood volume of neonates. Comparing the CLABSI rate observed in this cohort for the period 2020–2023 (2.9 per 1,000 catheter days) with the period 2015–2017 at our center (0.9 per 1,000 catheter days), we observe a notable increase. Unfortunately, catheter-specific CLABSI rates were not available for the earlier period (2015–2017) because the previous analysis did not specify the types of central catheters included. [43] In addition, the team was very satisfied with the very low CLABSI rate during the period 2015–2017, and the issue gradually lost focus. This situation offers several lessons: First, it shows that there is room for improvement. Although our current CLABSI rate is within a reasonable range compared to the literature, previous initiatives have shown that achieving a zero CLABSI rate is feasible. [44] Second, achieving a zero CLABSI rate over time requires iterative quality improvement cycles that include both clinical interventions and educational activities. These cycles need to be informed by accurate, real-time data. Third, it is essential to establish a comprehensive minimum data set on catheter use and CLABSI. This data set should include catheter-specific information on catheter days, dwell times and details of each identified CLABSI case. The high variability of annual data, influenced by individual cases, further emphasizes the importance of monitoring over time before drawing conclusions. Our study has several limitations. First, the retrospective design limits our ability to establish causality and only allows us to describe associations. Second, the small number of CLABSI cases in each catheter group limits the interpretation and analysis of our results. In addition, we lack data on process indicators during catheter insertion and maintenance - such as antiseptic procedures for insertion and number of catheter manipulations - that could influence the risk of CLABSI. Finally, we were unable to assess the contribution of peripheral intravenous catheters to the overall CLABSI burden, particularly in neonates with both central and peripheral catheters. Despite these limitations, the strength of our study lies in the detailed database of catheter-specific information, including catheter days, dwell times and associated CLABSI cases. This analysis can serve as a feasibility study, demonstrating the potential benefits of a minimal data set as a framework for CLABSI prevention management. Conclusion In this four-year retrospective study, with an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days, we observed a pronounced variation in CLABSI rates between different catheter types. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days, and the rate of CLABSI increased with longer dwell times for UVCs and CVCs. This suggests a reduction in dwell time as a potential strategy to minimize CLABSI. The minimal data set, which includes catheter-specific information such as catheter days, dwell times and associated CLABSI cases, has proven to be both feasible and valuable for future quality improvement programs aiming for a zero CLABSI rate. Abbreviations Central line associated blood stream infections (CLABSI), Neonatal Intensive Care Unit (NICU), umbilical venous catheters (UVC), umbilical artery catheters (UAC), peripherally inserted central catheters (PICC), centrally inserted venous catheters (CVC) Declarations Ethics approval and consent to participate: The study was approved by the Regional Ethics Committee (EKNZ) in Switzerland and the need for an informed consent was waived by the EKNZ (Project ID: 2022-02209). Consent for publication: Not applicable. Availability of data and materials: The datasets and/or analysed during the study are included in this published article or are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: There was no specific funding for this study. Authors’ contributions: MAB made significant contributions to the conception, the data acquisition, the interpretation of data and drafted the first version of the manuscript. CLL made significant contributions to the conception, the interpretation of data and substantively revised the manuscript. MIB made significant contributions to the conception, the interpretation of data and substantively revised the manuscript. DIL made significant contributions to the conception, the data analysis, design of figures and substantively revised the manuscript. MAS made significant contributions to the conception, the data acquisition, the interpretation of data, design of figures and substantively revised the manuscript. Acknowledgements: Barbara Imboden, data manager of the NICU/Neonatology at the Children’s Hospital of Central Switzerland. 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Intensive Care Med 2013;39:1352e8. Schulman J, Stricof RL, Stevens TP, et al. Development of a statewide collaborative to decrease NICU central line-associated bloodstream infections. J Perinatol 2009;29:591e9. Trotter CW. Percutaneous central venous catheter-related sepsis in the neonate: an analysis of the literature from 1990 to 1994. Neonatal Network 1996;15:15–28. Trotter CW. Percutaneous central venous catheters in neonates: a descriptive analysis and evaluation of predictors for sepsis. Journal of Perinatal and Neonatal Nursing 1996; 10:56–71. Mahieu LM, De Dooy JJ, De Muynck AO, Van Melckebeke G, Ieven MM, Van Reempts PJ. Microbiology and risk factors for catheter exit-site and -hub colonization in neonatal intensive care unit patients. Infection Control and Hospital Epidemiology 2001;22:357–62. Cartwright DW. Central venous lines in neonates: a study of 2186 catheters. Archives of Disease in Childhood. Fetal and Neonatal Edition 2004;89:F504–8. van der Zwet WC, Kaiser AM, van Elburg RM, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. Journal of Hospital Infection 2005;61:300–11. Garland JS, Alex CP, Sevallius JM, et al. Cohort study of the pathogenesis and molecular epidemiology of catheter- related bloodstream infection in neonates with peripherally inserted central venous catheters. Infection Control and Hospital Epidemiology 2008;29:243–9. Olsen AL, Reinholdt J, Jensen AM, Andersen LP, Jensen ET. Nosocomial infection in a Danish Neonatal Intensive Care Unit: a prospective study. Acta Paediatrica 2009;98: 1294–9. Whited A, Lowe JM. Central Line-Associated Bloodstream Infection: Not Just an Intensive Care Unit Problem. Oncology Nursing Society 2013;17(1), 21-24. Payne V, Hall M, Prieto J, Johnson M. Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2018 Sep;103(5):F422-F429. Bierlaire S, Danhaive O, Carkeek K, Piersigilli F. How to minimize central line-associated bloodstream infections in a neonatal intensive care unit: a quality improvement intervention based on a retrospective analysis and the adoption of an evidence-based bundle. Eur J Pediatr. 2021 Feb;180(2):449-460. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf Shalabi M, Adel M, Yoon E, et al. Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates. Pediatrics. 2015 Dec;136(6):1073-9. Sanderson E, Yeo KT, Wang AY, et al. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect. 2017 Nov;97(3):267-274. Lindquist S, Hentz E, Tessin I, Elfvin A. Very low birthweight infants face an increased risk of bloodstream infections following the removal of umbilical catheters. Acta Paediatr. 2016 Apr;105(4):391-6. Sengupta A, Lehmann C, Diener-West M, Perl TM, Milstone AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics. 2010 Apr;125(4):648-53. Milstone AM, Reich NG, Advani S, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013 Dec;132(6):e1609-15. Folgori L, Bielicki J, Sharland M A systematic review of strategies for reporting of neonatal hospital-acquired bloodstream infections Archives of Disease in Childhood - Fetal and Neonatal Edition 2013;98:F518-F523. Jansen SJ, Broer SDL, Hemels MAC, et al. Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. J Hosp Infect. 2024 Feb;144:20-27. Jansen SJ, van der Hoeven A, van den Akker T, et al. A longitudinal analysis of nosocomial bloodstream infections among preterm neonates. Eur J Clin Microbiol Infect Dis. 2022 Nov;41(11):1327-1336. Nielsen CL, Zachariassen G, Holm KG. Central line-associated bloodstream infection in infants admitted to a level lllneonatal intensive care unit. Dan Med J. 2022 Apr 7;69(5):A05210463. Greenberg RG, Cochran KM, Smith PB, et al. Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants. Pediatrics. 2015 Dec;136(6):1080-6. Bayoumi MAA, van Rens R, Chandra P, et al. Peripherally inserted central catheters versus non- tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study. BMJ Open 2022;12:e058866. Yamaguchi RS, Noritomi DT, Degaspare NV, et al. Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis. Intensive Care Med. 2017 Aug;43(8):1097-1104. Catho G, Rosa Mangeret F, Sauvan V, et al. Risk of catheter-associated bloodstream infection by catheter type in a neonatal intensive care unit: a large cohort study of more than 1100 intravascular catheters. J Hosp Infect. 2023 Sep;139:6-10. Zheng X, He D, Yang Z,et al. Dwell time and bloodstream infection incidence of umbilical venous catheterization in China. Pediatr Investig. 2023 Oct 15;7(4):239-246. Yumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr. 2013 Jul;102(7):e293-8. Hess S, Poryo M, Ruckes C, et al. Assessment of an umbilical venous catheter dwell-time of 8-14 days versus 1-7 days in very low birth weight infacts (UVC - You Will See): a pilot single-center, randomized controlled trial. Early Hum Dev. 2023 Apr;179:105752. Corso L, Buttera M, Candia F, et al. Infectious Risks Related to Umbilical Venous Catheter Dwell Time and Its Replacement in Newborns: A Narrative Review of Current Evidence. Life (Basel). 2022 Dec 31;13(1):123. Grasso F, Capasso A, Pacella D, et al. Ultrasound Guided Catheter Tip Location in Neonates: A Prospective Cohort Study. J Pediatr. 2022 May;244:86-91.e2. Sabouneh R, Akiki P, Al Bizri A, El Helou S, Zeidan S, Al Hamod D. Ultrasound guided central line insertion in neonates: Pain score results from a prospective study. J Neonatal Perinatal Med. 2020;13(1):129-134. Lau CS, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016 Aug;80(2):178-84. Dahan M, O'Donnell S, Hebert J, et al. CLABSI Risk Factors in the NICU: Potential for Prevention: A PICNIC Study. Infect Control Hosp Epidemiol. 2016 Dec;37(12):1446-1452. Stoll BJ, Gordon T, Korones SB, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Develop- ment Neonatal Research Network. J Pediatr 1996;129:63e71 Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualised catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol 2011;32:42e9. Struthers S, Underhill H, Albersheim S, Greenberg D, Dobson S. A comparison of two versus one blood culture in the diagnosis and treatment of coagulase-negative staphylococcus in the neonatal intensive care unit. J Perinatol 2002;22:547e9. Steinmann KE, Lehnick D, Buettcher M, et al. Impact of Empowering Leadership on Antimicrobial Stewardship: A Single Center Study in a Neonatal and Pediatric Intensive Care Unit and a Literature Review. Front Pediatr. 2018 Oct 12;6:294. Pearlman SA. Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero. Am J Perinatol. 2020 Sep;37(S 02):S14-S17. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Sep, 2025 Read the published version in Antimicrobial Resistance & Infection Control → Version 1 posted Editorial decision: Revision requested 27 Jun, 2025 Reviews received at journal 26 Jun, 2025 Reviews received at journal 12 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers agreed at journal 28 May, 2025 Reviewers invited by journal 13 May, 2025 Editor assigned by journal 12 May, 2025 Submission checks completed at journal 12 May, 2025 First submitted to journal 10 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6633395","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":455800365,"identity":"cb8f1a79-a5b9-4d50-9500-5b12376fd2db","order_by":0,"name":"Martina Buttera","email":"","orcid":"","institution":"Children’s Hospital of Central Switzerland","correspondingAuthor":false,"prefix":"","firstName":"Martina","middleName":"","lastName":"Buttera","suffix":""},{"id":455800366,"identity":"f6c19bd2-a222-43b9-8403-7054f3232956","order_by":1,"name":"Carolyn Luhmann-Lunt","email":"","orcid":"","institution":"Children’s Hospital of Central Switzerland","correspondingAuthor":false,"prefix":"","firstName":"Carolyn","middleName":"","lastName":"Luhmann-Lunt","suffix":""},{"id":455800367,"identity":"1e8d19ec-6bd1-4ecc-9e3e-a746aa7d9349","order_by":2,"name":"Michael Buettcher","email":"","orcid":"","institution":"Children’s Hospital of Central Switzerland","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Buettcher","suffix":""},{"id":455800368,"identity":"7d49f598-b8cf-4d29-aa39-793b9a626d17","order_by":3,"name":"Lehnick Dirk","email":"","orcid":"","institution":"CTU-CS, University of Lucerne","correspondingAuthor":false,"prefix":"","firstName":"Lehnick","middleName":"","lastName":"Dirk","suffix":""},{"id":455800369,"identity":"dfc41988-53ad-42fc-9e1e-c3023d77da23","order_by":4,"name":"Stocker Martin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIie3OsQrCMBCA4QsduhzOFcQ3ECKCk9hXMQjt4kMEhHaJu4/i4BAp6JLaVXCpFOrsZsHBaAVxMHV0yA/huOEjB2Cz/WuTejj6jTqAehBuBIQ/CNYkwN8IvEnSTHpxes5PK/B9d17QyzpDqnY5VKvvZKjCPmcKmMDtgC3LI9JUULJQBiIDwlkEE/RmToJSkwzBIZGBZOWT+E9yk3tN3NxMDvUvRGgyBSn1YZw2kJIsWeQxobaDvpBTbCtFNwvjYQFcqmjku/G88K5y3G2p8JRXBvLK+1xlI7DZbDabsTtkAFGC6zNnkQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Lucerne","correspondingAuthor":true,"prefix":"","firstName":"Stocker","middleName":"","lastName":"Martin","suffix":""}],"badges":[],"createdAt":"2025-05-10 08:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6633395/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6633395/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13756-025-01618-2","type":"published","date":"2025-09-26T15:57:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82887787,"identity":"983b472a-90d7-44e5-a533-9de55e73b7f6","added_by":"auto","created_at":"2025-05-16 11:58:34","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":283448,"visible":true,"origin":"","legend":"\u003cp\u003eDwell-times in days by catheter type.\u003c/p\u003e\n\u003cp\u003eDwell-times are presented as box plot with median, interquartile range and outliers. PICC = Peripherally inserted central line, UVC = umbilical venous catheter, UAC = umbilical arterial catheter, CVC = centrally inserted venous catheter\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6633395/v1/ab5fea976b948c4500c8e618.jpg"},{"id":82889537,"identity":"ec9af327-6f8f-4e67-8952-18e7015cedcc","added_by":"auto","created_at":"2025-05-16 12:06:35","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":207028,"visible":true,"origin":"","legend":"\u003cp\u003eCLABSI-free time, all catheters\u003c/p\u003e\n\u003cp\u003eCentral line associated blood stream infection (CLABSI) events analyzed using a time-to-event analysis per catheter (all catheter types) with graphical displays of Kaplan-Meier estimates.\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6633395/v1/cbc7b576e73887d64a72072a.jpg"},{"id":82887791,"identity":"80cb8bc5-dc58-4fcc-926d-de292f7224b4","added_by":"auto","created_at":"2025-05-16 11:58:34","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":210173,"visible":true,"origin":"","legend":"\u003cp\u003eCLABSI-free time per catheter type\u003c/p\u003e\n\u003cp\u003eCentral line associated blood stream infection (CLABSI) events analyzed using a time-to-event analysis per catheter type with graphical displays of Kaplan-Meier estimates. A) Peripherally inserted central line (PICC), B) Umbilical arterial catheter (UAC), C) Umbilical venous catheter (UVC), D) Centrally inserted venous catheter (CVC)\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6633395/v1/223394f96b579f454c79d7a8.jpg"},{"id":92430708,"identity":"25560ccb-a0c2-4417-a39c-3a4774e6d68a","added_by":"auto","created_at":"2025-09-29 16:07:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1864344,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6633395/v1/1c73af35-63e2-4c1f-999b-7c0d630867bb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The impact of central line-specific dwell-times for neonatal central line associated catheter infections: A population-based descriptive analysis in Central Switzerland","fulltext":[{"header":"Background","content":"\u003cp\u003eIt is widely recognized that the use of central catheters can expose neonates to a variety of complications. Immediate complications may include injury to nearby structures, phlebitis, air embolism, hematoma, arrhythmia and malposition. Later complications include infection, occlusion, thrombosis, infiltration, extravasation and catheter migration. [1\u0026ndash;3] Central line-associated bloodstream infections (CLABSIs) are the most common and serious complication associated with the use of central catheters in neonates. CLABSIs are also the most common nosocomial infection, accounting for up to 50% of all hospital-acquired sepsis cases. [4\u0026ndash;7] Between 5% and 30% of neonates with a central line will develop a bloodstream infection, leading to increased morbidity, mortality and healthcare costs. [8\u0026ndash;14] Premature infants, particularly those with very low birth weight, are at higher risk of CLABSI due to their immature immune systems and the extensive use of central venous catheters for essential medical care. [15]\u003c/p\u003e \u003cp\u003eUnlike other neonatal infections, CLABSIs are often preventable, and healthcare professionals should work continuously to improve central line management. In recent years, significant efforts have been made to identify effective preventive strategies, commonly referred to as 'bundles of care', to reduce CLABSI rates. A meta-analysis of 24 studies showed an average reduction in CLABSI rates of 60% following implementation of these bundles in neonatal intensive care units. [16] In clinical practice, these bundles need to be continuously reviewed and updated with the latest international guidelines to improve the quality of care. [17]\u003c/p\u003e \u003cp\u003ePrompt removal of central lines when no longer needed is one of the most widely reported strategies for reducing the risk of CLABSI. [16,17] However, there is a lack of clear evidence in the neonatal literature on the maximum safe central line dwell time and the benefits of prophylactic removal or replacement. In addition, the risk of infection may vary depending on the type of central catheter used - such as umbilical venous catheters (UVCs), umbilical arterial catheters (UACs), peripherally inserted central catheters (PICCs) or centrally inserted venous catheters (CVCs) - suggesting that the maximum dwell time may be different for each. We hypothesize that in order to effectively reduce neonatal CLABSI rates, it is crucial to understand catheter-specific CLABSI rates. This requires analysis of both the types of catheters used and their dwell times. In this descriptive study, we will examine CLABSI cases focused on catheter type and dwell time over a four-year period in a Swiss neonatal intensive care unit (NICU). In addition, we aim to demonstrate the feasibility and potential benefits of a minimal CLABSI dataset as a basis for the development of effective future quality improvement programs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We conducted a retrospective, single-center study of CLABSI cases in all neonates admitted to the Department of Neonatology and Pediatric Intensive Care at the Children's Hospital of Central Switzerland from 1 January 2020 to 31 December 2023. The Intensive Care Unit has 9 beds, and the Intermediate and Long-Term Care Unit has 29 beds. We are a level III referral center for central Switzerland with a neonatal surgical program that includes minimally invasive surgery. Our perinatal network links us to nine maternity units and we admit around 2,000 neonates per year. As there are no other children's hospitals or neonatal units in the region, all neonates requiring specialist care are transferred to our center. Although it is possible for neonates requiring highly specialized care to be transferred to tertiary centers outside central Switzerland, this only happens occasionally due to a lack of beds at our center. As a result, we can report data that are almost population based.\u003c/p\u003e \u003cp\u003eInclusion criteria and definitions\u003c/p\u003e \u003cp\u003eWe included in the study all newborns within 44 weeks of gestational age admitted to our NICU/Neonatology from 1 January 2020 to 31 December 2023. Each case with a positive blood culture was individually investigated to assess whether the infection was catheter-related or not. CLABSI was defined according to the latest CDC criteria as a laboratory-confirmed bloodstream infection (LCBI) in which an eligible bloodstream infection (BSI) pathogen is identified, and an eligible central line is present either on the day of the LCBI event or the day before. The CLABSI rate is defined as the total number of CLABSI divided by the total number of device days x 1000 [18]. We analyzed CLABSI associated with UVC, UAC, PICC and CVC. CVC included jugular, brachiocephalic and femoral central lines.\u003c/p\u003e \u003cp\u003eCentral line management and CLABSI prevention strategies\u003c/p\u003e \u003cp\u003eDuring the study period, a UVC was used as the standard central catheter for all preterm infants born before 32 weeks' gestation and for all neonates requiring resuscitation or intubation in the delivery room or within the first 24 hours of life. A UAC was used as the standard catheter for all preterm infants born before 28 weeks' gestation and for all neonates requiring resuscitation, intubation or catecholamines in the delivery room or within the first 24 hours of life. PICCs were used as standard catheters for all neonates requiring central access after UVC removal. CVCs were used for neonates requiring surgery or in unstable conditions requiring intubation, resuscitation or catecholamines beyond the first few days of life.\u003c/p\u003e \u003cp\u003eThe standard operating procedure for CLABSI prevention remained unchanged throughout the study. The CLABSI bundle included strict aseptic protocols for central catheter insertion, hygiene guidelines for catheter care, and maximum dwell times of 7 days for UVC, UAC and PICC. The maximum dwell time for each central line could be extended by the treating physician in certain situations. There was no defined maximum dwell time for CVC. In cases of suspected late-onset sepsis (LOS), the standard operating procedure (SOP) recommended starting antibiotic therapy with amikacin and amoxicillin with clavulanic acid. This antibiotic regimen for LOS was determined regardless of the presence of a central line.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eIn autumn 2019, the hospital implemented the new patient data management system from EPIC. The electronic medical records were used to assess the annual catheter days and the different types of catheters. For each patient, the following information was collected from the electronic database: sex, gestational age, birth weight, mode of delivery, history of congenital heart disease, NEC or hypothermia, and presence of a central catheter. For each central catheter inserted, we analyzed the type and median dwell time. From the microbiology database, we collected information on the microorganism identified in blood cultures, date of infection, antibiotic treatment, occurrence of CLABSI, and any CLABSI-related complications such as need for invasive ventilation, inotropic support, or mortality. The study was approved by the Regional Ethics Committee (EKNZ) and the need for an informed consent was waived by the EKNZ (Project ID: 2022\u0026ndash;02209). Data were accessed by the data manager of the unit from March 1, 2024 until May 31, 2024. After the process of data access by the data manager, patient data were stored in a secure and anonymized database. All analyses by the author team were done using the anonymized database. The study fulfills the criteria of the STROBE checklist regarding cohort studies.\u003c/p\u003e \u003cp\u003eStatistical analyses\u003c/p\u003e \u003cp\u003eAll data reported have been analyzed both overall the 4 years and annually. Descriptive data is presented as median and interquartiles [Q1, Q3] for continuous variables and as frequency (%) for categorical variables. The dwell-times by catheter were illustrated in a Box plot. CLABSI events were analyzed using a time-to-event analysis per catheter, including graphical displays of Kaplan-Meier estimates. Statistical analyses of dwell-times and the time-to-event analysis of CLABSI events were performed using StataNow (Version 18.5, StataCorp, College Station, Texas, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 27,636 neonates were born in the catchment area between the beginning of 2020 and the end of 2023. Of this population, 2599 neonates (9.4%) were admitted to our hospital and 615 neonates (23.7%) had at least one central line. The annual data are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. When analyzing the specific central catheter type, PICC was used most frequently in 312 neonates (50.7%) with a total of 3423 catheter days (69.3% of all catheter days), followed by UVC in 167 neonates (27.2%) with 709 catheter days (14.4%) and UAC in 104 neonates (16.9%) with 411 catheter days (8.3%). CVC was used least in 32 neonates (5.2%) with 397 catheter days (8.0%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). When analyzing the median dwell time of the different types of catheters, CVCs were left in place the longest ones with a median dwell-time of 10 days, followed by PICCs (6 days), UVCs (4 days) and UACs (3 days) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics of the population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLive-born infants in the catchment area of Central Switzerland\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNewborns admitted to NICU/Neonatology (% live-born)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNewborns with a central catheter (% admitted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNewborns with CLABSI episode (% with a central line\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e640 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e172 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e676 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e157 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e656 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e152 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e627 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2020\u0026ndash;2023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2599 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e615 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14 (2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNICU\u0026thinsp;=\u0026thinsp;Neonatal intensive care unit, CLABSI\u0026thinsp;=\u0026thinsp;central line associated blood stream infection\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCatheter data and central line associated blood stream infection (CLABSI) rates\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2020\u0026ndash;2023\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients with a central catheter: n\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients with PICC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79 (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e312 (50.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients with UVC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e167 (27.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients with UAC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e104 (16.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients with CVC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (5.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal number of catheters: n\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of PICC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119 (59.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e133 (67.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e533 (62.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of UVC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e176 (20.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of UAC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e112 (13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of CVC: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDwell time of all catheter types in days: Median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (3\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (3\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (3\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (3\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (3\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDwell time of PICC in days: Median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (4\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDwell time of UVC in days: Median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5 (1-6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (2\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDwell time of UAC in days: Median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (2\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDwell time of CVC in days: Median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.5 (5-13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (1\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (5-11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (7-17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (4\u0026ndash;13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCatheter days all together: n\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4940\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePICC days: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e921 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e937 (70.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e765 (69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e800 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3423 (69.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUVC days: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e215 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e192 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e118 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e709 (14.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUAC days: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (7\u0026thinsp;\u0026minus;\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e411 (8.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVC days: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e109 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e397 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLABSI rate (all catheter types)/1000 catheter days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLABSI rate (PICC)/1000 catheter days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLABSI rate (UVC)/1000 catheter days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLABSI rate (UAC)/1000 catheter days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLABSI rate (CVC)/1000 catheter days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ePICC\u0026thinsp;=\u0026thinsp;Peripherally inserted central line, UVC\u0026thinsp;=\u0026thinsp;umbilical venous catheter, UAC\u0026thinsp;=\u0026thinsp;umbilical arterial catheter, CVC\u0026thinsp;=\u0026thinsp;centrally inserted venous catheter, IQR\u0026thinsp;=\u0026thinsp;interquartile range\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA total of 14 cases of CLABSI were identified. The overall and annual CLABSI rates by catheter type are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The observed overall CLABSI rate was 2.9/1000 catheter days, lowest for PICC (0.9/1000 catheter days) and highest for CVC (17.9/1000 catheter days). Annual data are highly variable. The time-to-event curves show that there were no cases of CLABSI within the first 5 days of dwell time (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After nine days, the rate of CLABSI increases compared to the window between 6 and 9 days. When comparing the different catheter types, the time-to-event curves of UVC and CVC show similar trends with increasing rates of CLABSI as the dwell time of the specific catheter increases. The PICC time-to-event curve remains more stable and there were no cases of CLABSI with UACs. UVC-associated CLABSIs were observed after a dwell time of 6 to 10 days, PICC-associated CLABSIs after 7 to 12 days and CVC-associated CLABSIs after 9 to 20 days (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the main characteristics of the 14 cases of CLABSI, including the specific catheter responsible for the episode, the dwell time and the severity of the CLABSI cases, defined as the need for mechanical ventilation or inotropes or death related to the infection. Two of the 14 cases were classified as severe CLABSI. The first patient with severe CLABSI required mechanical ventilation within 48 hours of blood culture collection, despite appropriate empirical treatment. The second case had an underlying genetic disorder, which was confirmed during the CLABSI episode, and after discussion with the parents, the child was transferred to palliative care and died.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetailed description of all central line associated blood stream infection (CLABSI) episodes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGA at positive Blood culture (weeks)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge at positive Blood culture (days)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMain diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAssociated Catheter type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCatheter dwell time until CLABSI (days)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMicroorganism identified\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdequate antibiotic treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eCLABSI severity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMechanical ventilation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eInotrope medications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrematurity, severe BPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePICC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Capitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNEC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVC (femoral)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Aureus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrematurity, acute kidney failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePICC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Capitis, Staphylococcus Epidermidis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003econgenital diaphragmatic hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVC (jugular)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Epidermidis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrematurity, bilateral renal vein thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePICC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Aureus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNEC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVC (jugular)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Aureus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNEC, ultra-short bowel syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVC (jugular)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEnterobacter Cloacae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrematurity, meningitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePseudomonas Aeruginosa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrematurity, meningitis, endocarditis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Aureus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrematurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Epidermidis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrematurity, ROP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Aureus, Klebsiella Pneumoniae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNEC, partial monosomy cr. 8, partial trisomy cr. 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVC (jugular)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Epidermidis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNEC, partial monosomy cr. 8, partial trisomy cr. 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVC (femoral)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Epidermidis, Klebsiella Oxytoca\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJejunal atresia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVC (brachiocephalic vein)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaphylococcus Epidermidis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePICC\u0026thinsp;=\u0026thinsp;Peripherally inserted central line, UVC\u0026thinsp;=\u0026thinsp;umbilical venous catheter, UAC\u0026thinsp;=\u0026thinsp;umbilical arterial catheter, CVC\u0026thinsp;=\u0026thinsp;centrally inserted venous catheter. NEC\u0026thinsp;=\u0026thinsp;necrotizing enterocolitis, ROP\u0026thinsp;=\u0026thinsp;retinopathy, BPD\u0026thinsp;=\u0026thinsp;bronchopulmonary dysplasia.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e, followed by \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eStaphylococcus capitis\u003c/em\u003e were the most common pathogens responsible for CLABSI. In 11 out of 14 neonates (78%), empirical antibiotic therapy was appropriate, with at least one antimicrobial agent effective against the pathogen. The most commonly used antibiotics for empirical treatment of CLABSIs were the combination of amikacin and amoxicillin with clavulanic acid. The three CLABSI cases with inappropriate primary antibiotic therapy were two cases of \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e and one case of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. None of these were serious infections and all neonates recovered fully.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this four-year retrospective study, we observed an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days. The rate varied significantly by catheter type: 0 per 1,000 catheter days for UACs, 0.9 per 1,000 catheter days for PICCs, 5.6 per 1,000 catheter days for UVCs, and 17.9 per 1,000 catheter days for CVCs. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days. The rate of CLABSI increased with longer dwell times for UVCs and CVCs.\u003c/p\u003e \u003cp\u003eIn the literature, most studies on neonatal CLABSI focus on the risk of infection associated with umbilical catheters and PICC lines. [19\u0026ndash;23] Although CVCs are less commonly used in neonates, the high CLABSI rate associated with CVCs in our cohort highlights the need to include CVCs in analyses of neonatal CLABSI. Our overall CLABSI rate of 2.9 per 1,000 catheter days is consistent with other studies and is among the lowest reported neonatal CLABSI rates. A systematic review published in 2013 reported neonatal CLABSI rates ranging from 3.2 to 21.8 per 1,000 catheter days [24]. A recent cohort study in the Netherlands evaluating CLABSI rates in nine neonatal centers found an incidence ranging from 2.9 to 16.1 per 1,000 catheter days [25]. A Danish study recently reported a neonatal CLABSI rate of 13.4 per 1,000 catheter days, and a longitudinal analysis over 10 years in a Dutch neonatal center found stable annual CLABSI rates with no trend between 8.8 and 25.3 per 1,000 catheter days [26, 27].\u003c/p\u003e \u003cp\u003eIn our cohort, the CLABSI rate varied significantly by catheter type. PICCs, which were the most commonly used central catheters (accounting for 69% of all catheter days), had a low infection rate of 0.9 per 1,000 catheter days. Notably, in the second half of the study period (2022 and 2023), with 1,565 PICC days, no PICC-related CLABSI cases were detected. This is lower compared to the literature, where most studies report a PICC-related CLABSI rates above 1 per 1,000 catheter days over several years. [20, 23, 28] Conversely, CVCs were used less frequently in our cohort (8% of all catheter days), but they had the highest CLABSI incidence, at 17.9 per 1,000 catheter days. This increased risk associated with CVCs compared to PICCs has been documented in other studies. For example, a retrospective study at a neonatal center in Qatar reported CLABSI rates of 1.8 and 3.3 per 1,000 catheter days for PICCs in 2016 and 2017, respectively, compared to 6.9 and 14.3 per 1,000 catheter days for CVCs. [29] Another retrospective study of four pediatric intensive care units in Brazil found that CVCs had an increased risk of CLABSI compared with PICCs, with an adjusted hazard ratio of 2.20 (95% CI 1.05\u0026ndash;4.61; p\u0026thinsp;=\u0026thinsp;0.037). [30] Umbilical catheters, which are commonly used in the early life of neonates, accounted for 22.7% of all catheter days in our cohort. We observed no case of CLABSI associated with UACs, but a relatively high rate of UVC-associated CLABSI at 5.6 per 1,000 catheter days. This is somewhat at odds with the literature, which generally reports similar CLABSI rates for UVCs and UACs, although our UVC-associated CLABSI rate is consistent with some reports. [31, 32] The increased risk of CLABSI associated with UVCs compared to PICCs is consistent with the existing literature, while the lower risk of UVC-related CLABSI compared to CVCs is inconsistent with some studies. [33]\u003c/p\u003e \u003cp\u003eIn our cohort, CVCs had the longest median dwell time (10 days) and the highest CLABSI rate (17.6 per 1,000 catheter days). Conversely, PICCs had the second longest median dwell time (6 days) and the lowest CLABSI rate (0.9 per 1,000 catheter days). This suggests that the risk of CLABSI cannot be attributed to dwell time alone. However, no CLABSI events were observed within 5 days, with increasing rates after 9 days. The rate of CLABSI increased further with longer dwell times for UVCs and CVCs (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Therefore, the risk of CLABSI appears to be a function of catheter type and dwell time (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The literature on catheter-specific risk of CLABSI and dwell time is highly controversial. Some studies have found no significant differences in UVC-associated CLABSI rates up to 14 days, while others report a stepwise increase in risk after the first few days. [20, 27, 31, 32, 34] As a result, recommendations are inconsistent. A recent review of 177 articles on the maximum duration of UVCs and neonatal CLABSI concluded that there is insufficient strong evidence and broad consensus to replace UVCs after 14 days. The review cautiously suggested that replacing UVCs within 7 days may help prevent CLABSI. [35] The literature on PICCs is even more mixed. Some studies found no significant association between PICC dwell time and PICC-associated neonatal CLABSI rates, while others observed a statistically significant increase in CLABSI rates with dwell times of 8 to 13 days or more than 14 days compared with shorter dwell times. [20, 23, 27, 28]\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWhen analyzing the 14 cases of CLABSI in our cohort, we observed dwell times for the specific catheter type within the last two days or later of the expected maximum according to our SOP for the prevention of CLABSI. Due to the small number of CLABSI cases in our cohort, we cannot make statistical associations. However, with the goal of zero CLABSI rates, one potential strategy is to focus on minimizing the maximum length of stay. In our study, all four UVC-associated CLABSI cases occurred after 5 days, the three PICC-associated CLABSI cases after 7 days, and the CVC-associated CLABSI cases after 9 days. This suggests that setting and adhering to new catheter-specific maximum dwell times may be beneficial. However, without robust evidence from the literature on optimal dwell times, we must weigh the benefits against the risks of such a strategy. Reducing dwell times could lead to increased pain from more frequent punctures, increased radiation exposure, and potential complications from new central catheter insertions. [34] On the other hand, the recent introduction of procedural ultrasound has greatly assisted neonatologists in central catheter placement. This advance has reduced the number of attempts required, reduced radiation exposure and lowered the incidence of complications, making it an integral part of routine clinical practice. [36, 37, 38] In addition to catheter type and dwell time, clinical circumstances need to be taken into account. Although this is not possible for the entire cohort of patients with a central line, the observation of several neonates with CLABSI and intra-abdominal pathology (NEC, jejunal atresia, diaphragmatic hernia) suggests that this condition may be a specific risk for CLABSI (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This is consistent with the literature showing an increased risk of CLABSI in cases with intra-abdominal pathology. [39]\u003c/p\u003e \u003cp\u003e \u003cem\u003eCoagulase-negative staphylococci\u003c/em\u003e emerged as the most common pathogens involved in CLABSI pathogenesis due to their ability to colonize the skin and form biofilms on indwelling devices, as confirmed by several other studies [22, 23, 40, 41]. In 10 out of 14 CLABSI cases in our cohort (71%), staphylococci were the responsible pathogen. Of the 14 cases of CLABSI, only two were considered \"severe\": one in an extremely preterm patient with a UVC in place for 10 days and another in a patient with NEC and a genetic disorder who had a femoral CVC in place for 19 days. Both patients with severe CLABSI received appropriate empirical antibiotic treatment from the outset. It is important to note that we defined CLABSI cases on the basis of a single positive blood culture. A study comparing one versus two blood cultures in the diagnosis and management of coagulase-negative staphylococcal infections found an 8.2% higher detection rate with one versus two cultures. [42] Most neonatal units use the single blood culture strategy because of the limited blood volume of neonates.\u003c/p\u003e \u003cp\u003eComparing the CLABSI rate observed in this cohort for the period 2020\u0026ndash;2023 (2.9 per 1,000 catheter days) with the period 2015\u0026ndash;2017 at our center (0.9 per 1,000 catheter days), we observe a notable increase. Unfortunately, catheter-specific CLABSI rates were not available for the earlier period (2015\u0026ndash;2017) because the previous analysis did not specify the types of central catheters included. [43] In addition, the team was very satisfied with the very low CLABSI rate during the period 2015\u0026ndash;2017, and the issue gradually lost focus. This situation offers several lessons: First, it shows that there is room for improvement. Although our current CLABSI rate is within a reasonable range compared to the literature, previous initiatives have shown that achieving a zero CLABSI rate is feasible. [44] Second, achieving a zero CLABSI rate over time requires iterative quality improvement cycles that include both clinical interventions and educational activities. These cycles need to be informed by accurate, real-time data. Third, it is essential to establish a comprehensive minimum data set on catheter use and CLABSI. This data set should include catheter-specific information on catheter days, dwell times and details of each identified CLABSI case. The high variability of annual data, influenced by individual cases, further emphasizes the importance of monitoring over time before drawing conclusions.\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, the retrospective design limits our ability to establish causality and only allows us to describe associations. Second, the small number of CLABSI cases in each catheter group limits the interpretation and analysis of our results. In addition, we lack data on process indicators during catheter insertion and maintenance - such as antiseptic procedures for insertion and number of catheter manipulations - that could influence the risk of CLABSI. Finally, we were unable to assess the contribution of peripheral intravenous catheters to the overall CLABSI burden, particularly in neonates with both central and peripheral catheters. Despite these limitations, the strength of our study lies in the detailed database of catheter-specific information, including catheter days, dwell times and associated CLABSI cases. This analysis can serve as a feasibility study, demonstrating the potential benefits of a minimal data set as a framework for CLABSI prevention management.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this four-year retrospective study, with an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days, we observed a pronounced variation in CLABSI rates between different catheter types. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days, and the rate of CLABSI increased with longer dwell times for UVCs and CVCs. This suggests a reduction in dwell time as a potential strategy to minimize CLABSI. The minimal data set, which includes catheter-specific information such as catheter days, dwell times and associated CLABSI cases, has proven to be both feasible and valuable for future quality improvement programs aiming for a zero CLABSI rate.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCentral line associated blood stream infections (CLABSI), Neonatal Intensive Care Unit (NICU), umbilical venous catheters (UVC), umbilical artery catheters (UAC), peripherally inserted central catheters (PICC), centrally inserted venous catheters (CVC)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was approved by the Regional Ethics Committee (EKNZ) in Switzerland and the need for an informed consent was waived by the EKNZ (Project ID: 2022-02209).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets and/or analysed during the study are included in this published article or are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThere was no specific funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003eMAB made significant contributions to the conception, the data acquisition, the interpretation of data and drafted the first version of the manuscript. CLL made significant contributions to the conception, the interpretation of data and substantively revised the manuscript. MIB made significant contributions to the conception, the interpretation of data and substantively revised the manuscript. DIL made significant contributions to the conception, the data analysis, design of figures and substantively revised the manuscript. MAS made significant contributions to the conception, the data acquisition, the interpretation of data, design of figures and substantively revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eBarbara Imboden, data manager of the NICU/Neonatology at the Children\u0026rsquo;s Hospital of Central Switzerland.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKornbau C, Lee KC, Hughes GD, et al. Central line complications. 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Pediatrics. 2010 Apr;125(4):648-53. \u003c/li\u003e\n\u003cli\u003eMilstone AM, Reich NG, Advani S, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013 Dec;132(6):e1609-15. \u003c/li\u003e\n\u003cli\u003eFolgori L, Bielicki J, Sharland M A systematic review of strategies for reporting of neonatal hospital-acquired bloodstream infections Archives of Disease in Childhood - Fetal and Neonatal Edition 2013;98:F518-F523.\u003c/li\u003e\n\u003cli\u003eJansen SJ, Broer SDL, Hemels MAC, et al. Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. J Hosp Infect. 2024 Feb;144:20-27. \u003c/li\u003e\n\u003cli\u003eJansen SJ, van der Hoeven A, van den Akker T, et al. A longitudinal analysis of nosocomial bloodstream infections among preterm neonates. Eur J Clin Microbiol Infect Dis. 2022 Nov;41(11):1327-1336. \u003c/li\u003e\n\u003cli\u003eNielsen CL, Zachariassen G, Holm KG. Central line-associated bloodstream infection in infants admitted to a level lllneonatal intensive care unit. Dan Med J. 2022 Apr 7;69(5):A05210463. \u003c/li\u003e\n\u003cli\u003eGreenberg RG, Cochran KM, Smith PB, et al. Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants. Pediatrics. 2015 Dec;136(6):1080-6. \u003c/li\u003e\n\u003cli\u003eBayoumi MAA, van Rens R, Chandra P, et al. Peripherally inserted central catheters versus non- tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study. BMJ Open 2022;12:e058866. \u003c/li\u003e\n\u003cli\u003eYamaguchi RS, Noritomi DT, Degaspare NV, et al. Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis. Intensive Care Med. 2017 Aug;43(8):1097-1104. \u003c/li\u003e\n\u003cli\u003eCatho G, Rosa Mangeret F, Sauvan V, et al. Risk of catheter-associated bloodstream infection by catheter type in a neonatal intensive care unit: a large cohort study of more than 1100 intravascular catheters. J Hosp Infect. 2023 Sep;139:6-10. \u003c/li\u003e\n\u003cli\u003eZheng X, He D, Yang Z,et al. Dwell time and bloodstream infection incidence of umbilical venous catheterization in China. Pediatr Investig. 2023 Oct 15;7(4):239-246. \u003c/li\u003e\n\u003cli\u003eYumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr. 2013 Jul;102(7):e293-8. \u003c/li\u003e\n\u003cli\u003eHess S, Poryo M, Ruckes C, et al. Assessment of an umbilical venous catheter dwell-time of 8-14 days versus 1-7 days in very low birth weight infacts (UVC - You Will See): a pilot single-center, randomized controlled trial. Early Hum Dev. 2023 Apr;179:105752. \u003c/li\u003e\n\u003cli\u003eCorso L, Buttera M, Candia F, et al. Infectious Risks Related to Umbilical Venous Catheter Dwell Time and Its Replacement in Newborns: A Narrative Review of Current Evidence. Life (Basel). 2022 Dec 31;13(1):123.\u003c/li\u003e\n\u003cli\u003eGrasso F, Capasso A, Pacella D, et al. Ultrasound Guided Catheter Tip Location in Neonates: A Prospective Cohort Study. J Pediatr. 2022 May;244:86-91.e2. \u003c/li\u003e\n\u003cli\u003eSabouneh R, Akiki P, Al Bizri A, El Helou S, Zeidan S, Al Hamod D. Ultrasound guided central line insertion in neonates: Pain score results from a prospective study. J Neonatal Perinatal Med. 2020;13(1):129-134. \u003c/li\u003e\n\u003cli\u003eLau CS, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016 Aug;80(2):178-84. \u003c/li\u003e\n\u003cli\u003eDahan M, O\u0026apos;Donnell S, Hebert J, et al. CLABSI Risk Factors in the NICU: Potential for Prevention: A PICNIC Study. Infect Control Hosp Epidemiol. 2016 Dec;37(12):1446-1452. \u003c/li\u003e\n\u003cli\u003eStoll BJ, Gordon T, Korones SB, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Develop- ment Neonatal Research Network. J Pediatr 1996;129:63e71\u003c/li\u003e\n\u003cli\u003eZingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualised catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol 2011;32:42e9.\u003c/li\u003e\n\u003cli\u003eStruthers S, Underhill H, Albersheim S, Greenberg D, Dobson S. A comparison of two versus one blood culture in the diagnosis and treatment of coagulase-negative staphylococcus in the neonatal intensive care unit. J Perinatol 2002;22:547e9.\u003c/li\u003e\n\u003cli\u003eSteinmann KE, Lehnick D, Buettcher M, et al. Impact of Empowering Leadership on Antimicrobial Stewardship: A Single Center Study in a Neonatal and Pediatric Intensive Care Unit and a Literature Review. Front Pediatr. 2018 Oct 12;6:294. \u003c/li\u003e\n\u003cli\u003ePearlman SA. Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero. Am J Perinatol. 2020 Sep;37(S 02):S14-S17. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"antimicrobial-resistance-and-infection-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aric","sideBox":"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)","snPcode":"13756","submissionUrl":"https://submission.nature.com/new-submission/13756/3","title":"Antimicrobial Resistance \u0026 Infection Control","twitterHandle":"@ARICJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CLABSI, NICU, central catheters, umbilical catheters, PICC-lines, neonates, dwell-time","lastPublishedDoi":"10.21203/rs.3.rs-6633395/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6633395/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCentral line-associated bloodstream infections (CLABSIs) are among the most serious infectious complications associated with central lines in neonates. CLABSIs can be prevented by healthcare workers using \"bundles\" when inserting and managing central lines. These include prompt removal of the central line when it is no longer needed. The aim of this study was to describe and analyze neonatal CLABSIs, focusing on a minimal data set including specific catheter types and dwell times.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A retrospective descriptive study reviewing the management and outcome of neonates with CLABSI admitted to the Department of Neonatology and Neonatal Intensive Care at the Children's Hospital of Central Switzerland in Lucerne from 1 January 2020 to 31 December 2023.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn this four-year period, a total of 27,636 neonates were born in the catchment area and 2599 neonates (9.4%) were admitted to our hospital. In total, 615 neonates (23.7%) had at least one central line with a total of 4940 catheter days. We observed an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days. The rate varied significantly by catheter type: 0 per 1,000 catheter days for umbilical artery catheters (UACs), 0.9 per 1,000 catheter days for peripherally inserted central lines (PICCs), 5.6 per 1,000 catheter days for umbilical venous catheters (UVCs), and 17.9 per 1,000 catheter days for centrally inserted venous catheters (CVCs). All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe observed a pronounced variation in CLABSI rates between different catheter types. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days, and the rate of CLABSI increased with longer dwell times for UVCs and CVCs. This suggests a reduction in dwell time as a potential strategy for future quality improvement programs aiming for a zero CLABSI rate and underlines the importance of reporting central-line specific dwell-times for future publications.\u003c/p\u003e","manuscriptTitle":"The impact of central line-specific dwell-times for neonatal central line associated catheter infections: A population-based descriptive analysis in Central Switzerland","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 11:58:30","doi":"10.21203/rs.3.rs-6633395/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-27T07:12:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T15:45:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T17:19:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180243704438403595821105895988037998539","date":"2025-06-05T13:23:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213378089423371015283367237216417930032","date":"2025-05-28T16:57:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-13T07:53:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-12T19:55:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-12T12:14:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"Antimicrobial Resistance \u0026 Infection Control","date":"2025-05-10T07:58:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"antimicrobial-resistance-and-infection-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aric","sideBox":"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)","snPcode":"13756","submissionUrl":"https://submission.nature.com/new-submission/13756/3","title":"Antimicrobial Resistance \u0026 Infection Control","twitterHandle":"@ARICJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d537b1b1-3d93-4c8c-ab30-eb818f934235","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T16:05:11+00:00","versionOfRecord":{"articleIdentity":"rs-6633395","link":"https://doi.org/10.1186/s13756-025-01618-2","journal":{"identity":"antimicrobial-resistance-and-infection-control","isVorOnly":false,"title":"Antimicrobial Resistance \u0026 Infection Control"},"publishedOn":"2025-09-26 15:57:37","publishedOnDateReadable":"September 26th, 2025"},"versionCreatedAt":"2025-05-16 11:58:30","video":"","vorDoi":"10.1186/s13756-025-01618-2","vorDoiUrl":"https://doi.org/10.1186/s13756-025-01618-2","workflowStages":[]},"version":"v1","identity":"rs-6633395","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6633395","identity":"rs-6633395","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}