The role of central venous catheter salvage in children

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Our objective was to examine the outcome of attempted line salvage in children with S. aureus CLABSI and assess predictors of success” Corkum et al (2017).

Abstract:

BACKGROUND: Prompt central venous catheter (CVC) removal is currently recommended in children with Staphylococcus aureus central line-associated bloodstream infection (CLABSI). Our objective was to examine the outcome of attempted line salvage in children with S. aureus CLABSI and assess predictors of success.

METHODS: A single-institution, retrospective cohort study was performed of all children with S. aureus CLABSI between 2012 and 2015. Patients with and without immediate CVC removal (≤ 2 days after first positive culture) were compared. The primary outcome was failed CVC salvage (removal after 3+ days).

RESULTS: Seventy-seven children met criteria for S. aureus CLABSI. Immediate CVC removal was performed in 27.3% of patients. Among the 72.7% patients in whom CVC salvage was attempted, 78.6% were successful and 21.4% required delayed CVC removal. Malignancy, short gut syndrome, neutropenia, methicillin-resistant S. aureus, and line type were not associated with salvage failure. No associated morbidity or mortality occurred in patients with a failed salvage attempt. New or recurrent bacteremia occurred in five patients, but three were successfully salvaged a second time.

CONCLUSIONS: CVC salvage was feasible in the majority of children with S. aureus CLABSI and was not associated with significant complications or attributable mortality as reported in adults.

Reference:

Corkum, K.S., Jones, R.E., Reuter, C.H., Kociolek, L.K., Morgan, E. and Lautz, T.B. (2017) Central venous catheter salvage in children with Staphylococcus aureus central line-associated bloodstream infection. September 25th. [epub ahead of print].

doi: 10.1007/s00383-017-4165-5.

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