Characteristics of Catheter-Related Bloodstream Infections in Children With Intestinal Failure

Abstract

Catheter-related bloodstream infection is a major cause of mortality and morbidity in the intestinal-failure population. This study reports characteristics of CRBSI with implications for clinical management in parenteral nutrition-dependent children with intestinal failure. The researchers report the rate of central catheter infections, and the causative organisms, as well as identify risk factors in our intestinal-failure patients that would be amenable to preventive measures.The study is a retrospective review of the medical records of 101 patients with intestinal failure (IF), seen in the Intestinal Rehabilitation Clinic at Children's Medical Center of Dallas from May 2005 to March 2007. Catheter-related bloodstream infections (CRBSIs) were categorized as nosocomial or community-acquired. Data collected for each episode include microorganisms isolated from blood and potential risk factors. Z test was done to compare the infection rates.There were 92 episodes of CRBSIs in 45 parenteral nutrition (PN)-dependent patients with central venous catheters (CVC) in place for a total of 13,978 days. Eighty-three percent (n = 76) of CRBSIs developed in the community at a rate of 7.0 per 1,000 days. Seventeen percent (n = 16) nosocomial CRBSIs were observed at a rate of 5.5 per 1,000 catheter days. CRBSI rate was not statistically different between the two groups (7.0 vs. 5.5, p = .378).CRBSI in the intestinal-failure population is due to a wide variety of organisms with numerous risk factors. Education of CVC management with the practice of consistent guidelines may reduce CRBSI incidence, thus reducing the morbidity and mortality in the intestinal-failure patients.

Aseptic non‐touch technique and catheter‐related bloodstream infection in children receiving parenteral nutrition at home

“…17 Drews et al reported seven infections per 1000 catheter-days in 45 children on PN at home over two years' follow-up. 19 In our cohort, the incidence of CRBSI was 1.3 infections per 1000 catheter-days in children receiving PN at home, at the lower end of the previously reported range.…”

“…The reported average indwelling time for CVC in children with PN at home was between 244 and 780 days. 17,19,32 This study has a number of limitations: the sample size is small and we collected only one year of patients' data. We do not have a control group; to compare our findings we used the previously published incidence of CRBSI.…”

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

“…For example, pediatric patients with short gut syndrome, who are dependent upon parenteral nutrition, are at high risk for recurrent central line infections and thus may have higher cumulative antibiotic exposure than even some critical care and oncology patients. [34][35][36][37] For such patients, pathogens causing CLABSIs may be more likely to be antibiotic resistant. Other potential explanations include differences in infection control practices or opportunities for transmission in pediatric ward locations compared to critical care or oncology locations.…”

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

“…12 However, utilization of PN is associated with a high incidence of catheter-associated bloodstream infections (CA-BSI). [13][14][15] The incidence of Background: Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-associated bloodstream infections (CA-BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA-BSI in children receiving HPN are limited.…”