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Outcome of Pediatric Gastroenterology Outpatients With Fever and Central Line
Thomas Alexander1, Julie Blatt, Asheley Cockrell Skinner
1From the Departments of *Internal Medicine and †Pediatrics, Divisions of ‡Pediatric Hematology Oncology, §General Pediatrics and Adolescent Medicine, ∥Pediatric Infectious Disease, and ¶Pediatric Gastroenterology, #University of North Carolina School of Medicine, Chapel Hill, NC.
Insights
Pediatric gastroenterology outpatients with central venous catheters (CVCs) and fever have a high risk of bloodstream infections. Subspecialty-specific management protocols are needed, and these patients often require hospital admission for monitoring.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Vascular Access Devices
Background:
- Management protocols for fever in pediatric oncology patients with central venous catheters (CVCs) exist.
- Clear protocols are lacking for pediatric outpatients with non-cancer diagnoses and CVCs presenting with fever.
Purpose of the Study:
- To assess outcomes for pediatric outpatients with gastrointestinal disorders presenting with fever and a CVC.
- To compare bloodstream infection rates and characteristics between pediatric gastroenterology (PGI) and pediatric oncology (PO) outpatients with fever and CVCs.
Main Methods:
- Retrospective study using microbiology and emergency department records (January 2010-December 2012).
- Inclusion of PGI and PO outpatients with fever and CVC, excluding those with severe neutropenia.
- Chart review for demographic and clinical characteristics.
Main Results:
- 53% of PGI patients had bloodstream infections versus 9% of PO patients (P < 0.001).
- PGI patients with bloodstream infections were more likely to have polymicrobial, gram-negative, and enteric organism infections.
- PGI patients had higher CVC removal rates (19% vs 4%) but similar ICU needs.
Conclusions:
- Pediatric gastroenterology outpatients with fever and CVCs exhibit a high prevalence of bloodstream infections.
- Management algorithms should be tailored to specific subspecialties.
- Admission for monitoring and management is recommended for PGI patients presenting with fever and CVC.
Objective:
Although management algorithms for fever and central venous catheters (CVCs) have been implemented for pediatric oncology (PO) patients, management of pediatric outpatients with noncancer diagnoses and CVCs lacks clear protocols. The aim of the study was to assess outcomes for pediatric outpatients with gastrointestinal disorders presenting with fever and CVC.
Methods:
Using a microbiology database and emergency department records, we created a database of pediatric gastroenterology (PGI) and PO outpatients with fever and a CVC who presented to our emergency department or clinics from January 2010 through December 2012. We excluded patients who had severe neutropenia (absolute neutrophil count, <500/mm). We performed chart reviews to assess demographic and clinical characteristics.
Results:
A total of 334 episodes in 144 patients were evaluated. Fifty-three percent (95% confidence interval, 38%-68%) of PGI patients had a bloodstream infection, whereas only 9% (95% confidence interval, 5%-14%) of PO patients had a bloodstream infection (P < 0.001). Among patients with a bloodstream infection, the PGI patients were more likely than the PO patients to have polymicrobial infections (46% vs 15%), gram-negative infections (57% vs 27%), and/or infection with enteric organisms (61% vs 23%). The PGI patients had higher rates of CVC removal (19% vs 4%) but no statistical difference in intensive care unit needs (11% vs 4%).
Conclusions:
Pediatric gastroenterology outpatients with fever and a CVC have a high prevalence of bloodstream infection. Algorithms for management need to be subspecialty specific. Pediatric gastroenterology patients presenting to emergency departments or clinics with fever and CVC require admission for monitoring and management.
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