Sampling Multiple Catheter Lumens to Improve Detection of Bloodstream Infection in Pediatric Oncology Patients

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Critical Care Medicine

Background:

• Current guidelines suggest culturing all lumens of central venous catheters in febrile pediatric oncology patients.
• Diagnostic stewardship programs aim to reduce unnecessary laboratory testing, including blood cultures, in critically ill children.

Purpose of the Study:

• To evaluate the necessity of culturing each central venous catheter lumen in febrile pediatric oncology patients within intensive care units.
• To assess the impact of diagnostic stewardship on the detection of bacteremia when not all lumens are cultured.

Main Methods:

• Retrospective analysis of blood cultures from pediatric oncology patients admitted to the intensive care unit.
• Comparison of results from cultures drawn from each central venous catheter lumen.

Main Results:

• Out of 34 eligible blood culture sets, 11 (34%) showed discordant results.
• Discordant results frequently involved a pathogen identified in one lumen but not others.
• This highlights potential underdiagnosis of bacteremia if not all lumens are sampled.

Conclusions:

• Culturing each central venous catheter lumen is essential for accurate bacteremia detection in febrile pediatric oncology patients.
• This practice is critical for optimizing diagnosis, even in settings with diagnostic stewardship programs.
• Reducing testing without considering lumen-specific results may compromise patient care.