Is antibiotic lock therapy effective for the implantable longterm catheter-related bloodstream infections in children?

Area of Science:

• Pediatric Infectious Diseases
• Medical Microbiology
• Clinical Pharmacy

Background:

• Catheter-related bloodstream infections (CRBSIs) pose significant morbidity and mortality risks in pediatric patients with central venous catheters.
• Identifying causative pathogens and evaluating treatment efficacy are crucial for managing CRBSIs.

Purpose of the Study:

• To determine the incidence of CRBSIs in pediatric hematology, oncology, and immunology patients.
• To identify the common pathogens responsible for CRBSIs.
• To evaluate the effectiveness and outcomes of antibiotic lock therapy (ALT) for pediatric CRBSIs.

Main Methods:

• Retrospective analysis of pediatric patients diagnosed with CRBSIs between January 2010 and November 2015.
• Calculation of CRBSI incidence per 1000 catheter days.
• Review of pathogens isolated and treatment outcomes, including ALT administration and catheter removal.

Main Results:

• The incidence of CRBSIs was 4.20/1000 catheter days.
• Methicillin-resistant coagulase-negative Staphylococcus was the most frequent pathogen, followed by Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli.
• Antibiotic lock therapy (ALT) demonstrated an 81% success rate (34/42 patients), with catheter removal necessary in 36 episodes, often due to sepsis or biofilm-forming microorganisms.

Conclusions:

• CRBSIs are a critical concern in pediatric oncology, hematology, and immunology.
• Antibiotic lock therapy (ALT) is a safe and effective treatment modality for pediatric CRBSIs, particularly when used with intravenous systemic antibiotics.
• ALT can help avoid unnecessary catheter removal in pediatric patients, though clinical judgment is required for cases involving severe sepsis or highly resistant pathogens.