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"Catheter salvage is possible in >75% CLABSIs. Effective antibiotic treatment without removal of the CVC should be considered as first line treatment and a single-lumen CVC should be the catheter of first choice" D'Eusebio et al (2021).

Catheter salvage is possible in >75% CLABSI

Abstract:

Introduction: Preserving venous access in children with intestinal failure(IF) requiring long-term parental nutrition(PN) can be critical for patient survival. Data regarding central venous catheter(CVC) salvage after a central line associated blood stream infection (CLABSI) are limited. We aimed to determine incidence of CLABSI and rates of CVC salvage in children receiving home PN.

Methods: We obtained records of all CLABSI in children receiving home PN from 2015-2019. All patients were at home with PN care managed by formally trained parents. Data obtained included demographics, underlying disease, CLABSI number per patient, microorganism(s) isolated and outcome. Catheter salvage rates were determined. Children with immunodeficiencies were excluded. Diagnosis of CLABSI was based on clinical manifestations such as fever, rigors, and/or hypotension and positive blood culture in the absence of other potential sources of infection. CVC were removed if potentially life-threatening symptoms occurred.

Results: There were 58 children(26 male, aged 7.2±4.6 years) with motility disorder in 44.8%, short bowel syndrome(SBS) in 36.2% and enteropathy in 19%. Catheters used were single-lumen tunneled Hickmann (82/108), double-lumen (26/108), peripheral inserted central catheter (2/108) and Broviac (1/108).

31/58 (53.4%; 15 M, aged 5.8±4.3 years) children developed 108 CLABSIs. Median(range) CLABSI number per patient was 1(0-14). Overall catheter days was 58414 and the CLABSI rate was 1.85/1000 catheter days.

23(21.3%) catheters were removed because of life-threatening symptoms and 85(78.7%) were salvaged.

By organism, 38% were gram positive, 34.2% gram negative, 21.2% polymicrobial and 6.5% fungal CLABSI. Commonest gram positive and negative organisms were Staphylococcus aureus (31.7%) and Klebsiella species (43.2%) respectively. Catheter infected with gram positive bacteria showed the highest salvage rate(gram positive 92.7%, 78.2% polymicrobial, 67.6% gram negative, 57.1% fungal infection; P<0.05).

Double-lumen catheter CLABSI rate was significantly >single-lumen(24.1% vs 4.8%; P<0.0001). Patients with a double-lumen CVC had an increased risk for CLABSI development (HR 2.51; [95% CI 1.70-3.86]; P <0.01).

Conclusion: Catheter salvage is possible in >75% CLABSIs. Effective antibiotic treatment without removal of the CVC should be considered as first line treatment and a single-lumen CVC should be the catheter of first choice. Further studies to identify predictive factors of catheter removal after CBLASI are required.

Reference:

D’Eusebio C, Puoti G, King E, Koeglmeier J, Hill S P-51: Successful Central Venous Catheter Salvage after Central Line Associated Blood Stream Infections(CLABSI) in Children on Long-term Home Parenteral Nutrition(PN). Transplantation. 2021 Jul 1;105(7S):S75. doi: 10.1097/01.tp.0000758008.64524.6d. PMID: 34793066.