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Challenging the 48-Hour Rule-Out for Central Line-Associated Bloodstream Infections in the Pediatric Intestinal
Melissa I Chang1, Sarah J Carlson1, Prathima Nandivada1
1The Department of Surgery and The Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
JPEN. Journal of Parenteral and Enteral Nutrition
|January 9, 2015
Summary
Central line-associated bloodstream infections (CLABSIs) in pediatric intestinal failure (IF) patients often show positive blood cultures within 24 hours. Absence of fever or leukocytosis does not rule out infection, suggesting potential for shorter hospital stays.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Parenteral nutrition (PN) is vital for intestinal failure (IF) patients.
- Central line-associated bloodstream infections (CLABSIs) are a major complication in IF.
- CLABSIs significantly increase mortality and morbidity in this vulnerable population.
Purpose of the Study:
- To characterize CLABSI presentation in pediatric IF patients.
- To determine the time to positivity for blood cultures in pediatric IF with CLABSI.
Main Methods:
- Retrospective cohort study of pediatric IF patients.
- Data collected from January 1, 2012, to December 31, 2012.
- Analysis included patient demographics, infection rates, and blood culture results.
Main Results:
- 33 CLABSIs occurred in 16 patients (1.5 infections/1000 catheter days).
- Fever (85%), elevated neutrophils, and C-reactive protein were common in CLABSI.
- Mean time to culture positivity was 13.2 hours; 97% positive within 24 hours.
Conclusions:
- Pediatric IF patients with CLABSI typically yield positive blood cultures within 24 hours.
- Absence of fever and leukocytosis does not exclude CLABSI.
- Findings may support shorter hospital stays for suspected CLABSI, warranting prospective validation.
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