This retrospective cohort study was done to evaluate the relationship between central venous catheter removal and outcome in bacteremic neonates. All neonates who had central venous access and developed bacteremia between July 1, 1995 and July 31, 1999 at Duke University NICU were included in the study population.

Results. The outcome for patients in whom the central catheter was not removed within 24 hours of organism identification was significantly worse (odds ratio = 9.8) than it was for those whose catheters were removed promptly. For patients who were infected with staphylococcus aureus or non-enteric Gram negative rods, delayed removal of central catheters was associated with complicated bacteremia. Catheter sterilization was attempted in 27 neonates who were infected with enteric Gram-negative rods; only 10 of these infants retained their catheters without infection-related complications. Infants who had 4 consecutive blood cultures that were positive for coagulase-negative staphylococcus (CoNS) were at significantly increased risk for end-organ damage and death, compared with infants who had 3 or fewer positive blood cultures for CoNS (odds ratio = 29.58). The data suggest that neonates infected with Staphyllococcus aureus or Gram-negative rods have fewer infection-related complications when their central catheters are removed promptly. For neonates with CoNS bacteremia, treatment with the catheter in place may be attempted, but documentation of subsequent negative blood cultures is crucial. Once a neonate has 3 positive blood cultures for CoNS, the central catheter should be removed.