Paediatric central line-associated bloodstream infections management
Abstract:
Background: Managing central-line-associated bloodstream infections (CLABSI) in children with long-term central venous catheters (CVC) is challenging. Catheter salvage strategy (CSS) can be attempted when intravenous therapy is essential, though it lacks standardization.
Aim: To evaluate CLABSI management and compare outcomes between children treated with CSS and CVC removal at a tertiary-care paediatric hospital METHODS: A retrospective cohort study included children diagnosed with CLABSI from January 2021 to June 2024. CSS was defined as CVC retention for at least 72 hours after starting empiric antibiotic therapy. Outcomes assessed included fever and bacteraemia persistence at 72 hours, length of stay, infectious complications, recurrence within 60 days, and treatment failure.
Findings: Among 111 CLABSI episodes (23 short-term, 88 long-term CVCs) early CVC removal was applied in 18.9%. CSS occurred in 88.6% of long-term CLABSIs. Early removal was associated with non-tunnelled CVCs, multi-lumen CVCs, and Candida spp. or Staphylococcus aureus CLABSI. CSS was associated with oncological patients and/or stem-cell transplant recipients. CSS achieved a 61.4% success rate without significant differences in treatment success between CSS and early CVC removal groups, nor across different pathogens.
Conclusion: In our cohort, CSS was widely used, with a success rate of 61.4% without differences across different pathogens. Further studies are needed to better define CSS’s role in paediatric CLABSI according to the aetiology and patient characteristics.
Reference:
Pellegrino R, Montagnani C, Timitilli E, Tondo A, Venturini E, Chiappini E, Galli L. Paediatric central line-associated bloodstream infections management: a retrospective study. Am J Infect Control. 2025 Oct 28:S0196-6553(25)00687-X. doi: 10.1016/j.ajic.2025.10.018. Epub ahead of print. PMID: 41167478.