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Management of catheter-related infections in pediatric patients
M C Nahata1, D R King, D A Powell
1College of Pharmacy, Ohio State University, Columbus 43205.
Insights
Catheter sepsis in children can often be treated with antibiotics alone, avoiding the need for Broviac catheter removal. A trial of antibiotic therapy is recommended before considering catheter removal for pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Medical Device Management
- Critical Care Medicine
Background:
- Broviac catheters are crucial for pediatric parenteral nutrition and drug delivery.
- Catheter-related sepsis is a significant complication, often necessitating catheter removal.
- Catheter removal may compromise essential patient care in pediatric cases.
Purpose of the Study:
- To evaluate the management of Broviac catheter-related infections in pediatric patients.
- To compare outcomes of sepsis treatment with and without catheter removal.
- To determine the efficacy of antibiotic therapy as a primary treatment for catheter sepsis.
Main Methods:
- Retrospective analysis of 77 episodes of catheter sepsis in 61 pediatric patients (neonates and older children).
- Evaluation of treatment strategies, including antibiotic therapy with or without catheter removal.
- Identification of causative microorganisms and assessment of antibiotic susceptibility patterns.
Main Results:
- 35 patients received antibiotics without catheter removal; 30 received targeted therapy.
- 26 of 30 patients on targeted antibiotics responded within 5 days.
- Lack of response was linked to abscess, immunocompromise, Pseudomonas aeruginosa, and Candida albicans.
Conclusions:
- Catheter sepsis in pediatric patients can be effectively managed with appropriate antibiotic therapy.
- A trial of antibiotics should be considered before Broviac catheter removal when continued use is necessary.
- Gentamicin and vancomycin combination therapy shows promise as initial treatment based on susceptibility data.
Abstract:
Broviac catheters are commonly used to provide parenteral nutrition and access for infusion of blood products and drugs to pediatric patients. Sepsis is the most common serious complication of continued catheter use. Although removal of the catheter is generally recommended when it becomes contaminated, it may not be feasible to do so without compromising patient care. We evaluated the management of catheter-related infections in pediatric patients with and without removal of catheter. Seventy-seven episodes of catheter sepsis were evaluated in 61 pediatric patients; 24 were neonates and 37 were older children. The catheters were used for multiple purposes in 75% of cases. The most common microorganisms isolated were Staphylococcus epidermidis in 26%, Klebsiella pneumoniae in 9%, and Streptococcus viridans in 8% of cases; other pathogens included group D Enterococcus, Staphylococcus aureus, and Escherichia coli. Pseudomonas aeruginosa was isolated in four older children. Thirty-five patients were treated with antibiotics without catheter removal. Thirty patients received appropriate antibiotic therapy based on the susceptibility data. Twenty-six of these 30 patients responded within 5 days of therapy whereas the others required 15-39 days of treatment. Lack of response was mainly associated with the presence of abscess, immunocompromised status, and organisms P. aeruginosa and Candida albicans. Based on the sensitivity and minimum inhibitory concentration data, a combined regimen of gentamicin and vancomycin would be an effective initial therapy. These findings suggest that (1) catheter sepsis can be managed with appropriate antibiotics, and (2) when continued use of Broviac catheter is desired, a trial of antibiotic therapy should be attempted before catheter removal.