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Prolonged bacteremia with catheter-related central venous thrombosis
D G Rupar1, K D Herzog, M C Fisher
1Section of Infectious Diseases, St Christopher's Hospital for Children, Philadelphia, Pa.
Insights
Central venous catheter use in children can lead to central venous thrombosis, a serious infection complication. Early suspicion and prompt treatment are crucial for managing persistent bacteremia in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Vascular Surgery
- Medical Imaging
Background:
- Central venous catheters (CVCs) are essential in pediatric care but associated with infectious complications.
- Central venous thrombosis (CVT) is an underrecognized complication of CVC use in children.
- Persistent bacteremia or fungemia in pediatric patients can indicate underlying complications.
Purpose of the Study:
- To report on the occurrence and characteristics of central venous thrombosis in children with persistent catheter-related infections.
- To highlight the diagnostic utility of ultrasonography in identifying CVT in this population.
- To discuss the clinical course and management of pediatric patients with CVT and persistent bacteremia.
Main Methods:
- Retrospective case series of seven pediatric patients.
- Diagnosis of central venous thrombosis confirmed by ultrasonography post-catheter removal.
- Clinical data including infection duration, treatment, and outcomes were analyzed.
Main Results:
- Seven pediatric patients presented with persistent bacteremia/fungemia despite CVC use.
- Ultrasonography confirmed central venous thrombosis in all seven patients after catheter removal.
- Bacteremia persisted for 6–35 days, with 5 patients positive for over 5 days post-catheter removal.
- Six patients received prolonged parenteral antibiotic therapy (>28 days).
Conclusions:
- Central venous thrombosis should be strongly suspected in pediatric patients with persistent catheter-related bacteremia.
- Ultrasonography is a valuable tool for diagnosing CVT in this clinical setting.
- Optimal treatment strategies for pediatric CVT remain to be determined, but prolonged antibiotic therapy appears beneficial for survivors.
Abstract:
Infection of a central venous thrombus is a serious but rarely recognized complication of the use of central venous catheters in children. We report the cases of seven children with persistent bacteremia or fungemia in which central venous thrombosis was demonstrated by ultrasonography after removal of the catheter. All patients had signs and symptoms of infection, but only one had clinical evidence of central venous stasis. Bacteremia persisted from 6 to 35 days. Infection did not resolve in any patient prior to catheter removal, and five patients had positive blood cultures for 5 or more days after removal of the catheter. Six patients, including all who survived, were treated parenterally with antibiotics for more than 28 days. Two patients died; neither death was directly attributable to infection. Central venous thrombosis should be suspected in patients with persistent catheter-related bacteremia. Optimal treatment of this problem is not yet known.