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[Conservative approach in children with central line infection]
Z Steiner1, Y Kandelis, G Mogilner
1Dept. of Pediatric Surgery, and Hematology, Bnei-Zion Medical Center, Technion, Haifa.
Insights
A conservative approach to treating central venous catheter infections in children is feasible for catheter-related infections, often allowing for home treatment and reducing hospital stays. However, tunnel infections may require catheter removal.
Area of Science:
- Pediatric Infectious Diseases
- Vascular Access Devices
- Hospital-Acquired Infections
Context:
- Central venous catheters (CVCs), primarily Broviac type, were placed in 47 children (7 days-16 years) for chemotherapy, total parenteral nutrition, prolonged antibiotics, and transfusions.
- Infections originating from the CVC occurred in 28% of cases (13 children), particularly in immunocompromised patients.
Purpose:
- To evaluate the efficacy of conservative antibiotic treatment for central venous catheter infections in pediatric patients.
- To assess the feasibility of home-based treatment and its impact on hospitalization.
Summary:
- Common pathogens included Staphylococcus aureus and Pseudomonas aeruginosa. Conservative antibiotic therapy through the catheter was successful in 10 cases without removal.
- Two cases of tunnel infection necessitated catheter removal. One patient self-removed the catheter. Superior vena cava thrombosis occurred in one child with recurrent tunnel infection.
Impact:
- Conservative treatment for CVC-related infections is effective in most cases, reducing hospitalization by 65 days (210 total days saved).
- Home-based treatment is cost-effective, conserves hospital resources, and is preferred by patients and families.
- Tunnel infections may be less responsive to conservative management, indicating a need for alternative strategies.
Abstract:
In 1994-1995, central venous lines were placed in 47 children. All except 1 were of the Broviac type, with subcutaneous tunneling via the internal or external jugular vein. Ages were between 7 days and 16 years. Indications for central venous cannulation were chemotherapy (35 cases), TPN (5), prolonged parenteral antibiotics (4), and repeated blood transfusions (3). The catheter was the source of infection in 13 children (28%), 11 of whom were immunocompromised. The commonly identified bacteria were Staphylococcus aureus (4 cases), Pseudomonas aeruginosa (4), coagulase-negative Staphylococcus (2), and various gram-negative rods (3). All cases were treated with antibiotics through the catheter. The most commonly used were oxacillin (4), ceftazidime (4), and amikacin (4). In 10, treatment succeeded without having to remove the line. In 2 others, tunnel infection developed and the catheter had to be removed. 1 child forcefully removed his catheter before treatment could be started. There were no further complications in the group treated conservatively, except for a case of superior vena cava thrombosis in a girl with recurrent infection of the tunnel. In 7 out of 13 treatment was continued and completed at home. This saved 65 days of hospitalization out of 210. We conclude that the conservative approach to treatment is feasible in most cases of infection when the source is the central venous catheter itself. However, when the tunnel is infected, conservative treatment may be ineffective. Treatment can be carried out in the home, with economy in cost and in use of hospital beds, and is preferred by patients and their parents.