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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Pediatric central line-associated bloodstream infections management: A retrospective study
Roberta Pellegrino1, Carlotta Montagnani2, Edoardo Timitilli1
1Department of Health Sciences, University of Florence, Florence, Italy.
Insights
Catheter salvage strategy (CSS) is effective for managing central-line-associated bloodstream infections (CLABSI) in children with long-term catheters, showing a 61.4% success rate. This approach offers comparable outcomes to catheter removal across various pathogens.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Stewardship
Background:
- Central-line-associated bloodstream infections (CLABSI) pose significant challenges in pediatric patients with long-term central venous catheters (CVC).
- Catheter salvage strategy (CSS) presents a viable option when maintaining intravenous access is critical.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of CLABSI management strategies in children.
- To compare catheter salvage strategy (CSS) versus early CVC removal in pediatric patients.
Main Methods:
- A retrospective cohort study analyzed 111 CLABSI episodes in children from January 2021 to June 2024.
- CSS involved CVC retention for at least 72 hours post-antibiotic initiation.
- Outcomes included fever/bacteremia persistence, hospital stay, complications, recurrence, and treatment failure.
Main Results:
- CSS was employed in 88.6% of long-term CVC-associated CLABSI cases.
- CSS demonstrated a 61.4% success rate, with no significant difference in treatment success compared to early CVC removal.
- Early removal was linked to non-tunnelled, multi-lumen CVCs, and specific pathogens like Candida spp. or Staphylococcus aureus.
Conclusions:
- Catheter salvage strategy is a widely utilized and successful approach for pediatric CLABSI.
- Further research is required to delineate the optimal role of CSS based on etiology and patient-specific factors.
Background:
Managing central-line-associated bloodstream infections (CLABSI) in children with long-term central venous catheters (CVC) is challenging. Catheter salvage strategy (CSS) can be attempted when intravenous therapy is essential.
Methods:
A retrospective cohort study at a tertiary-care paediatric hospital evaluated CLABSI management and compared outcomes between CSS and CVC removal, including all children with CLABSI from January 2021 to June 2024. CSS was defined as CVC retention for ≥ 72 hours after starting empiric antibiotic therapy. Outcomes assessed included fever and bacteraemia persistence at 72 hours, hospital stay, complications, recurrence within 60 days, and treatment failure.
Results:
Among 111 CLABSI episodes (23 short-term, 88 long-term CVCs) early CVC removal was applied in 18.9%. CSS occurred in 88.6% of long-term CLABSIs. Early removal was associated with non-tunnelled CVCs, multi-lumen CVCs, and Candida spp. or Staphylococcus aureus CLABSI. CSS was associated with oncological patients and/or stem-cell transplant recipients. CSS achieved a 61.4% success rate without significant differences in treatment success between CSS and early CVC removal groups, nor across different pathogens.
Conclusions:
CSS was widely used with a success rate of 61.4% without differences across pathogens. Further studies are needed to define CSS's role in children according to the aetiology and patient characteristics.
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