Clinical treatment on suspected CRBSI episodes

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Intravenous literature: Sumida, W., Watanabe, Y. and Takasu, H. (2011) Strategies for catheter-related blood stream infection based on medical course in children receiving parenteral nutrition. Pediatric Surgery International. Oct 19. [Epub ahead of print]

Abstract:

PURPOSE: The central venous catheter (CVC) is a useful device for patients requiring parenteral nutrition (PN). However, the risk for catheter-related blood stream infection (CRBSI) is always present. We analyzed the medical course pattern and considered the strategies against febrile events in patients with CVC.

METHODS: Nine patients receiving PN in our institute from January 2009 to December 2010 were reviewed. Statistical analysis was performed with the Mann-Whitney U test. A p value of

RESULTS: Eighty-four febrile events were observed. Fifty-six specimens had a positive blood culture, and 52 (93%) specimens were found to be positive in 48 h. The fever dissolved within 48 h in 76 (90%) events after our scheduled treatment. Between the positive and negative blood culture groups, no statistical difference was observed in the count of white blood cell (p = 0.15), the proportion of neutrophils (p = 0.11) and C-reactive protein (p = 0.64). None of the CVCs were removed because of failure to control infection.

CONCLUSION: We recommend the treatment for CRBSI be initiated when patients with CVC develop a high-grade fever, even before exact identification of the cause of infection. The treatment can be corrected after the re-evaluation at 48 h.

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