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Central Venous Catheter Management in High-risk Children With Bloodstream Infections
Shaina M Hecht1, Monica I Ardura1,2, Vedat O Yildiz3
1From the Department of Pediatrics, Division of Infectious Diseases.
Insights
Central venous catheter (CVC) removal is recommended for bloodstream infections (CLABSIs) but is often not followed. Attempting CVC salvage in children leads to higher treatment failure rates compared to timely removal.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- National guidelines advocate for central venous catheter (CVC) removal in cases of central line-associated bloodstream infections (CLABSIs) caused by specific pathogens like Staphylococcus aureus, Pseudomonas aeruginosa, and fungi.
- Limited data exist on guideline adherence and treatment outcomes for pediatric patients undergoing attempted CVC salvage for CLABSIs.
Purpose of the Study:
- To evaluate guideline compliance for CVC removal in pediatric CLABSI cases.
- To determine the treatment failure rates associated with CVC retention versus removal in pediatric patients with CLABSIs.
Main Methods:
- A retrospective analysis was conducted on high-risk pediatric patients (≤21 years) with long-term CVCs and CLABSIs caused by S. aureus, Pseudomonas spp., Candida spp., or Enterococcus spp. between 2009 and 2015.
- Data collected included adherence to national guidelines, CVC management (retention or removal), antimicrobial therapy, and treatment failure outcomes (relapse, recurrence, death).
- Multivariate logistic regression was used to identify factors associated with treatment failure.
Main Results:
- Out of 108 CLABSI episodes in 53 children, 33% involved CVC removal as per guidelines.
- Antimicrobial management was optimal in 50% of treated episodes, with no significant difference in treatment failure rates compared to suboptimal management.
- CVC retention was associated with a significantly higher treatment failure rate (31%) compared to CVC removal within 7 days (6%, P = 0.003).
Conclusions:
- Compliance with national guidelines for CVC removal in pediatric CLABSIs was suboptimal.
- Attempting CVC salvage in the majority of cases resulted in significantly higher treatment failure rates.
- Timely CVC removal is crucial for improving treatment outcomes in pediatric CLABSI patients.
Background:
National guidelines recommend removal of central venous catheters (CVCs) for central line-associated bloodstream infections (CLABSIs) caused by Staphylococcus aureus, Pseudomonas aeruginosa, and fungi. Data regarding guideline compliance and rates of associated treatment failures in pediatric patients with attempted CVC salvage are limited.
Methods:
We performed a retrospective analysis of high-risk children (age ≤ 21 years) hospitalized from 1/2009 to 12/2015 with a long-term CVC and CLABSI due to S. aureus, Pseudomonas spp., and Candida spp. Enterococcus spp. was included given differing management recommendations between short and long-term CVCs. Compliance with national guideline recommendations, as well as treatment failures including infection relapse, recurrence, and death were evaluated in relation to CVC retention or removal. Multivariate logistic regression modeling was performed to account for confounders impacting treatment failure.
Results:
Fifty-three children had 108 CLABSI episodes requiring 84 hospitalizations. CVCs were removed in 36 (33%) CLABSI episodes per guideline recommendations. Optimal antimicrobial management, including targeted agent and adequate duration was provided in 54 (50%) of 106 treated episodes; no significant difference in treatment failure rates were noted compared with episodes with suboptimal management. The treatment failure rate was significantly higher in patients with CVC retention compared those with CVC removal within 7 days of the first positive blood culture (31% vs. 6%, P = 0.003).
Conclusions:
Despite pathogen-specific guideline recommendations for CVC removal, compliance with national guidelines was poor. CVC salvage was attempted in the majority of CLABSI episodes in our cohort and resulted in a significantly higher treatment failure rate.
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