|Portfolio||Paediatric, foetal and maternal health|
Children who are admitted to hospital for intensive care often need to have medicines given directly into their veins, through a small plastic tube called a central venous catheter (CVC). CVCs avoid the need for repeated injections, but their disadvantage is an increased risk of bloodstream infection (BSI), which can result in prolonged treatment and time in hospital.
In adults, CVCs coated with medicine to kill bacteria (antibiotics) or prevent clots (heparin) have long been used to help reduce the risk of BSI. However, we did not know if coating the much narrower CVCs used for children would work in the same way. The only way to find out which type of CVC (standard non-coated, antibiotic coated or heparin coated) works best was to carry out a randomised controlled trial.
Children aged less than 16 years who needed a CVC for intensive care treatment were recruited into the CATCH trial from within 14 hospitals in England. Consent was provided for all participants in the trial. Each child had an equal chance of receiving one of the three CVC types.
Bloodstream infection occurred in 4% of children with standard CVCs and 2% of those with impregnated CVCs. Rates of BSI were lowest in the antibiotic CVC group (1%) but these children had slightly higher health-care costs for the 6 months after trial participation. Although doubt remains whether or not antibiotic CVCs would result in cost savings for the NHS in England, our results suggest that using antibiotic CVCs could help reduce BSI rates for children in intensive care.
- Gilbert, RE., et al. (2016) Impregnated central venous catheters for prevention of bloodstream infection in children (the CATCH trial): a randomised controlled trial
- Gilbert R, Mok Q, Dwan K, Harron K, Moitt T, Millar M, et al. Pragmatic randomised, controlled trial of impregnated central venous catheters for preventing bloodstream infection in children. Lancet 2016
- Harron K, Ramachandra G, Mok Q, Gilbert R. Consistency between guidelines and reported practice for reducing the risk of catheter-related infection in British paediatric intensive care units. Intens Care Med 2011;37(10):1641-1647
- Goldstein H, Harron K, Wade A. The analysis of record-linked data using multiple imputation with data value priors. Stat Med 2012; 31(28):3481-93
- Harron K, Lee T, Ball T, Mok Q, Gamble C, Macrae D, Gilbert R. Making co-enrolment feasible for randomised controlled trials in paediatric intensive care. PLoS One 2012;7(8): e41791
- Harron K, Goldstein H, Wade A, Muller-Pebody B, Parslow R, Gilbert R. Linkage, evaluation and analysis of national electronic healthcare data: application to providing enhanced blood-stream infection surveillance in paediatric intensive care. PLoS One 2013;8(12):e85278
- Harron K, Wade A, Gilbert R, Muller-Pebody B, Goldstein H. Evaluating bias due to data linkage error in electronic healthcare records. BMC Med Res Methodol 2014; 14(36)
- Harron K, Mok Q, Parlow R, Muller-Pebody B, Gilbert R, Ramnarayan P. Risk of bloodstream infection in children admitted to paediatric intensive care units in England and Wales following emergency inter-hospital transfer. Intens Care Med 2014;40:1916-23
- Harron K, Parslow R, Mok Q, Tibby S, Wade A, Muller-Pebody B, et al. Monitoring quality of care through linkage of administrative data: national trends in bloodstream infection in UK paediatric intensive care units 2003–2012. Crit Care Med 2015;43:1070–8
- Harron K, Woolfall K, Dwan K, Gamble C, Mok Q, Ramnarayan P, et al. Deferred consent for randomized controlled trials in emergency care settings. Pediatrics 2015;136:e1316–22
- Woolfall K, Frith L, Gamble C, Gilbert R, Mok Q, Young B, et al. How parents and practitioners experience research without prior consent (deferred consent) for emergency research involving children with life threatening conditions: a mixed method study. BMJ Open 2015;5:e008522