Outcomes in Pediatric Central Line–associated Bloodstream Infections Treated With Antimicrobial Locks: A 14-Year Retrospective Analysis

Abstract

Background: Central line–associated bloodstream infections (CLABSI) are the most common healthcare-associated infection in children. Antimicrobial lock therapy (ALT) is a recommended component of CLABSI treatment; however, studies characterizing pediatric ALT-based CLABSI therapy are few. Methods: All CLABSI treated with ALT at a single tertiary-care pediatric hospital for years 2004–2018 were identified by retrospective chart review and demographic, clinical, microbiological and pharmacy data were extracted. Three clinical outcomes were defined: CLABSI clearance, central venous catheter (CVC) removal and infection recurrence. Factors associated with these outcomes were examined and patterns in pathogen occurrence were described. Results: During the study period, 1188 CLABSI treated with ALT were identified. In all, 969 (85%) CLABSI initially cleared. In the CLABSI with initial clearance, CVCs were retained a median of 63 days after infection onset, and 20% recurred. Skin-colonizing microbes (Staphylococcus aureus, coagulase-negative Staphylococci) were more likely to produce monomicrobial infections, whereas bowel-colonizing microbes (Escherichia coli, Enterococci) were more associated with polymicrobial infections. In a multivariate model, infection history, resistant pathogens and CVC type were strongly correlated with infection recurrence, whereas bone marrow transplant status, neutrophil count and line type were correlated with CVC removal. Conclusions: Optimal therapeutic approaches to pediatric CLABSI remain uncertain, including the utility of ALT. Prior reports of ALT use in children have been smaller in size and largely described hematology-oncology or hemodialysis populations. We describe trends in pediatric CLABSI, including efficacy among solid organ transplant recipients and children with short-gut syndrome. These data provide guidance on selecting CLABSI for optimal ALT use.

Peripherally inserted central catheter securement with cyanoacrylate glue and bloodstream infection: A retrospective cohort study

“…Therefore, CG might provide additional infection‐prevention mechanisms than solely functioning as a physical barrier to bacteria. If catheter infection is suspected, it may be treated with antibiotics 30,31 . However, the patients in our study sample required a PICC for chemotherapy or perisurgical management; perhaps their immune system was suppressed.…”

“…If catheter infection is suspected, it may be treated with antibiotics. 30,31 However, the patients in our study sample required a PICC for chemotherapy or perisurgical management; perhaps their immune system was suppressed. Therefore, the F I G U R E 3 Kaplan-Meier curve for device failure owing to suspected catheter infection.…”

Antimicrobial Lock Therapy: Is it a real savior in pediatric hematopoetic stem cell transplant (HSCT) patients?

“…Thus, the decision to use ALT rather than CR is critical and mainly depends on the clinician's preference for this group of high-risk patients. To corroborate this, being a bone marrow transplant recipient and having neutropenia were identi ed as risk factors associated with CR among children with varied illnesses [17,18]. This study evaluated the ALT success rate among pediatric HSCT patients, contributing to the limited literature resources.…”