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Antibiotic Susceptibility and Therapy in Central Line Infections in Pediatric Home Parenteral Nutrition Patients
Bram P Raphael1, Greg Fournier1, Sarah R McLaughlin2
1Division of Gastroenterology, Hepatology and Nutrition.
Insights
Patients on home parenteral nutrition (HPN) are at high risk for central line-associated bloodstream infections (CLABSI). This study suggests empiric antibiotic therapy should cover methicillin-resistant staphylococci and enteric Gram-negative organisms.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Parenteral Nutrition Management
Background:
- Patients receiving home parenteral nutrition (HPN) face a significant risk of central line-associated bloodstream infections (CLABSI).
- Current management guidelines for antibiotic treatment of suspected CLABSI in this specific population are lacking.
- Historical microbiology data can inform the selection of empiric antimicrobial regimens for HPN patients.
Purpose of the Study:
- To analyze antimicrobial resistance patterns in children dependent on HPN who develop community-acquired CLABSI.
- To identify the most appropriate empiric antibiotic therapy for this patient group.
Main Methods:
- A single-center retrospective cohort study was conducted.
- Evaluated the potential coverage of empiric antibiotic regimens in children on HPN with community-acquired CLABSI.
Main Results:
- 309 CLABSI episodes occurred in 90 HPN-dependent children between 2011 and 2017.
- Gram-positive bacteria accounted for 60% of isolates, Gram-negative for 34%, and fungi for 6%.
- Antibiotic coverage was significantly better with vancomycin combined with cefepime (85%) or meropenem (96%) compared to piperacillin-tazobactam (69%).
Conclusions:
- Empiric antimicrobial therapy for suspected CLABSI in HPN-dependent children must include coverage for methicillin-resistant staphylococci and enteric Gram-negative organisms.
- Further research is necessary to assess clinical outcomes associated with evidence-based antimicrobial regimens.
Background:
Patients receiving home parenteral nutrition (HPN) are at high-risk for central line-associated bloodstream infections (CLABSI). There are no published management guidelines, however, for the antibiotic treatment of suspected CLABSI in this population. Historical microbiology data may help inform empiric antimicrobial regimens in this population.
Objective:
The aim of the study was to describe antimicrobial resistance patterns and determine the most appropriate empiric antibiotic therapy in HPN-dependent children experiencing a community-acquired CLABSI.
Methods:
Single-center retrospective cohort study evaluating potential coverage of empiric antibiotic regimens in children on HPN who developed a community-acquired CLABSI.
Results:
From October 1, 2011 to September 30, 2017, there were 309 CLABSI episodes among 90 HPN-dependent children with median age 3.8 years old.Fifty-nine percent of patients carried the diagnosis of surgical short bowel syndrome. Organisms isolated during these infections included 60% Gram-positive bacteria, 34% Gram-negative bacteria, and 6% fungi. Among all staphylococcal isolates, 51% were methicillin sensitive. Among enteric Gram-negative organisms, sensitivities were piperacillin-tazobactam 71%, cefepime 97%, and meropenem 99%. Organisms were sensitive to current institutional standard therapy with vancomycin and piperacillin-tazobactam in 69% of cases compared with vancomycin and cefepime or vancomycin an meropenem in 85% and 96% of cases (both P < 0.01).
Conclusions:
Empiric antimicrobial therapy for suspected CLABSI in HPN-dependent children should include therapy for methicillin-resistant staphylococci as well as enteric Gram-negative organisms. Future studies are needed to evaluate clinical outcomes based upon evidence-based antimicrobial regimens.
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