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Updated: Jun 23, 2025
Author Spotlight: Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model
Published on: March 31, 2023
Salvage strategy for long-term central venous catheter-associated Staphylococcus aureus infections in children: a
C Devautour1, N Poey2, J Lagier3
1Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France.
Insights
Catheter salvage strategy (CSS) was frequently used for children with Staphylococcus aureus central-line-associated bloodstream infection (CLABSI) involving long-term central venous catheters (LTCVC). However, CSS failure occurred in one-third of cases, highlighting the need to identify at-risk patients.
Area of Science:
- Pediatric Infectious Diseases
- Medical Device Infections
- Clinical Microbiology
Background:
- Catheter removal is standard for adult Staphylococcus aureus central-line-associated bloodstream infection (CLABSI), but its necessity in children with long-term central venous catheters (LTCVC) is debated.
- The catheter salvage strategy (CSS), involving leaving the LTCVC in place during antibiotic treatment, is an alternative approach in pediatric cases.
Purpose of the Study:
- To evaluate the utilization of CSS in children with S. aureus LTCVC-associated CLABSI.
- To identify factors associated with CSS failure in this pediatric population.
Main Methods:
- A retrospective study included children (<18 years) with S. aureus CLABSI and an LTCVC across eight French hospitals (2010-2018).
- CSS was defined as retaining the LTCVC for at least 72 hours after initiating antibiotic therapy.
- Multivariable logistic regression analyzed determinants of CSS failure, including persistent, recurrent, or complicated bacteremia.
Main Results:
- Of 273 S. aureus CLABSI episodes, CSS was employed in 194 cases (71%).
- CSS failure occurred in 74 episodes (38%), primarily due to persistent bacteremia (53% of failures).
- Independent risk factors for CSS failure included prior catheter infection, CLABSI on implantable devices, polymicrobial infections, and severe sepsis at presentation.
Conclusions:
- CSS is a common strategy for pediatric S. aureus CLABSI with LTCVCs, but failure rates approach one-third.
- Identifying children at higher risk for CSS failure is crucial for optimizing treatment and preventing complications.
Objectives:
Catheter removal is recommended in adults with Staphylococcus aureus central-line-associated bloodstream infection (CLABSI) but is controversial in children with long-term central venous catheters (LTCVC). We evaluated the occurrence of catheter salvage strategy (CSS) in children with S. aureus LTCVC-associated CLABSI and assessed determinants of CSS failure.
Methods:
We retrospectively included children (<18 years) with an LTCVC and hospitalized with S. aureus CLABSI in eight French tertiary-care hospitals (2010-2018). CSS was defined as an LTCVC left in place ≥72 h after initiating empiric antibiotic treatment for suspected bacteraemia. Characteristics of patients were reviewed, and multi-variable logistic regression was performed to identify factors associated with CSS failure (i.e., persistence, recurrence or complications of bacteraemia).
Results:
We included 273 episodes of S. aureus LTCVC-associated CLABSI. CSS was chosen in 194 out of 273 (71%) cases and failed in 74 of them (38%). The main type of CSS failure was the persistence of bacteraemia (39 of 74 cases, 53%). Factors independently associated with CSS failure were: history of catheter infection (adjusted odds ratio (aOR) 3.18, 95% confidence interval (CI) 1.38-7.36), CLABSI occurring on an implantable venous access device (aOR 7.61, 95% CI 1.98-29.20) when compared with tunnelled-cuffed CVC, polymicrobial CLABSI (aOR 3.45, 95% CI 1.25-9.50), and severe sepsis at the initial stage of infection (aOR 4.46, 95% CI 1.18-16.82).
Conclusions:
CSS was frequently chosen in children with S. aureus LTCVC-associated CLABSI, and failure occurred in one-third of cases. The identified risk factors may help clinicians identify children at risk for CSS failure.
