CLABSI treatment with broad spectrum gram-negative antibiotics
Broader spectrum gram-negative antibiotics are commonly utilized empirically for central line-associated bloodstream infections (CLABSI) in febrile short bowel syndrome (SBS) patients receiving home parenteral nutrition compared to those used empirically for inpatient-acquired CLABSI. This analysis reports 57 CLABSI in 22 patients with SBS admitted from the community and 78 inpatient-acquired CLABSI in 76 patients over a 5-year period. Proportional gram-negative CLABSI was similar between the SBS and inpatient-acquired cohorts (43.8% versus 42.3%, respectively, p = 0.78). 1.8% and 10.3% (p = 0.125) of gram-negative CLABSI were non-susceptible to ceftriaxone and 0% and 3.8% (p = 0.52) were non-susceptible to ceftazidime in the SBS and inpatient-acquired cohorts, respectively. In the SBS cohort, home ethanol lock therapy and prior culture results impacted gram-negative pathogen distribution. Broader empiric gram-negative coverage for CLABSI among SBS patients compared to inpatients is unnecessary. Third-generation cephalosporins represent appropriate empiric gram-negative agents for febrile SBS patients presenting from the community to our institution.
Stultz JS, Fly JH, Bagga B, Arnold SR, Algotar A, Lee KR. How Broad Should Gram-Negative Coverage be for Febrile Parenteral Nutrition Dependent Short Bowel Syndrome Patients? J Pediatr Gastroenterol Nutr. 2022 Jan 18. doi: 10.1097/MPG.0000000000003382. Epub ahead of print. PMID: 35045560.