Bloodstream infection in pediatric patients with intestinal failure and central venous catheters

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We conducted a retrospective cohort study of febrile patients younger than 18 years with diagnosis of intestinal failure requiring a central venous catheter for home parenteral nutrition to identify factors associated with normal blood cultures to identify a low-risk subset” Fischer et al (2019).

Abstract:

OBJECTIVES: This study aimed to describe demographic, clinical, and laboratory values in febrile pediatric intestinal failure patients with indwelling central venous catheters presenting to the emergency department to determine if there are low-risk features predictive of negative blood cultures that could help identify a subset that do not need hospitalization and/or broad-spectrum antibiotics.

METHODS: We conducted a retrospective cohort study of febrile patients younger than 18 years with diagnosis of intestinal failure requiring a central venous catheter for home parenteral nutrition to identify factors associated with normal blood cultures to identify a low-risk subset.

RESULTS: Of 119 encounters, 46% had a bloodstream infection. Children with a bloodstream infection were older than those without. A normal lactate and heart rate were associated with negative blood cultures.

CONCLUSION: Pediatric intestinal failure patients with a central venous catheter for home parenteral nutrition presenting to the emergency department with fever and found to have a normal lactate and heart rates had lower rates of bloodstream infection. Although we were unable to create a highly sensitive clinical decision-making rule to identify a low-risk cohort because of the low number of patients meeting both criteria, the promising candidate variables identified merit for future multicenter studies.

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Reference:

Fischer, J.B., Sturza, J., Kim, Z., James Lopez, M. and Rogers, A.J. (2019) Clinical Features and Biomarkers Suggestive of Bloodstream Infection in Pediatric Patients With Intestinal Failure and Central Venous Lines for Parenteral Nutrition: A Retrospective Pilot Study. Pediatric Emergency Care. January 21st. .

doi: 10.1097/PEC.0000000000001731.

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