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Outcomes in Pediatric Central Line-associated Bloodstream Infections Treated With Antimicrobial Locks: A 14-Year
Lorne W Walker1,2, Shyam Visweswaran3,4, Andrew J Nowalk5
1From the Division of Pediatric Infectious Disease.
Insights
Antimicrobial lock therapy (ALT) effectively treats pediatric central line-associated bloodstream infections (CLABSI), with 85% initial clearance. Recurrence was 20%, influenced by infection history and resistant pathogens.
Area of Science:
- Pediatric Infectious Diseases
- Healthcare Epidemiology
- Antimicrobial Stewardship
Background:
- Central line-associated bloodstream infections (CLABSI) are the most common healthcare-associated infections in children.
- Antimicrobial lock therapy (ALT) is recommended for CLABSI treatment, but pediatric data are limited.
Purpose of the Study:
- To characterize pediatric CLABSI treated with ALT.
- To identify factors associated with treatment outcomes and pathogen patterns.
Main Methods:
- Retrospective chart review of 1188 pediatric CLABSI cases treated with ALT (2004-2018).
- Data extraction included demographics, clinical, microbiological, and pharmacy information.
- Outcomes assessed: CLABSI clearance, central venous catheter (CVC) removal, and infection recurrence.
Main Results:
- 85% of CLABSI cases achieved initial clearance, with CVCs retained a median of 63 days.
- 20% of initially cleared infections recurred.
- Skin-colonizing microbes (e.g., Staphylococcus aureus) caused monomicrobial infections, while bowel microbes (e.g., E. coli) were linked to polymicrobial infections.
- Infection history, resistant pathogens, and CVC type predicted recurrence; transplant status and neutrophil count influenced CVC removal.
Conclusions:
- ALT is an effective component of pediatric CLABSI therapy, with varying efficacy across patient populations.
- Findings provide guidance for optimizing ALT use in pediatric CLABSI management.
- Further research is needed to refine therapeutic strategies for pediatric CLABSI.
Background:
Central line-associated bloodstream infections (CLABSI) are the most common healthcare-associated infection in children. Antimicrobial lock therapy (ALT) is a recommended component of CLABSI treatment; however, studies characterizing pediatric ALT-based CLABSI therapy are few.
Methods:
All CLABSI treated with ALT at a single tertiary-care pediatric hospital for years 2004-2018 were identified by retrospective chart review and demographic, clinical, microbiological and pharmacy data were extracted. Three clinical outcomes were defined: CLABSI clearance, central venous catheter (CVC) removal and infection recurrence. Factors associated with these outcomes were examined and patterns in pathogen occurrence were described.
Results:
During the study period, 1188 CLABSI treated with ALT were identified. In all, 969 (85%) CLABSI initially cleared. In the CLABSI with initial clearance, CVCs were retained a median of 63 days after infection onset, and 20% recurred. Skin-colonizing microbes ( Staphylococcus aureus , coagulase-negative Staphylococci) were more likely to produce monomicrobial infections, whereas bowel-colonizing microbes ( Escherichia coli , Enterococci) were more associated with polymicrobial infections. In a multivariate model, infection history, resistant pathogens and CVC type were strongly correlated with infection recurrence, whereas bone marrow transplant status, neutrophil count and line type were correlated with CVC removal.
Conclusions:
Optimal therapeutic approaches to pediatric CLABSI remain uncertain, including the utility of ALT. Prior reports of ALT use in children have been smaller in size and largely described hematology-oncology or hemodialysis populations. We describe trends in pediatric CLABSI, including efficacy among solid organ transplant recipients and children with short-gut syndrome. These data provide guidance on selecting CLABSI for optimal ALT use.
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