CLABSI salvage strategy for children with long-term CVC
Abstract:
Objectives: Catheter removal is recommended in adults with S. aureus central line-associated bloodstream infection (CLABSI) but is controversial in children with long-term central venous catheters (LTCVC). We evaluated the occurrence of catheter salvage strategy (CSS) in children with S. aureus LTCVC-associated CLABSI and assessed determinants of CSS failure.
Methods: We retrospectively included children (<18 years) with an LTCVC and hospitalized with S. aureus CLABSI in 8 French tertiary care hospitals (2010-2018). CSS was defined as an LTCVC left in place ≥ 72 hours after initiating empiric antibiotic treatment for suspected bacteremia. Characteristics of patients were reviewed, and multivariable logistic regression was performed to identify factors associated with CSS failure (i.e., persistence, recurrence, or complications of bacteremia).
Results: We included 273 episodes of S. aureus LTCVC-associated CLABSI. CSS was chosen in 194 out of 273 (71%) cases and failed in 74 of them (38%). The main type of CSS failure was the persistence of bacteremia (39 out of 74 cases, 53%). Factors independently associated with CSS failure were: history of catheter infection (adjusted odds ratio [aOR] 3.18, 95% confidence interval [95%CI] 1.38-7.36), CLABSI occurring on an implantable venous access device (aOR 7.61, 95%CI 1.98-29.20) when compared with tunneled-cuffed CVC, polymicrobial CLABSI (aOR 3.45, 95%CI 1.25-9.50), and severe sepsis at the initial stage of infection (aOR 4.46, 95%CI 1.18-16.82).
Conclusions: CSS was frequently chosen in children with S. aureus LTCVC-associated CLABSI, and failure occurred in one-third of cases. The identified risk factors may help clinicians identify children at risk for CSS failure.
Reference:
Devautour C, Poey N, Lagier J, Launay E, Cerdac A, Vergnaud N, Berneau P, Parize P, Ferroni A, Tzaroukian L, Pinhas Y, Pinquier D, Lorrot M, Dubos F, Caseris M, Ouziel A, Chalumeau M, Cohen JF, Toubiana J. Salvage strategy for long-term central venous catheter-associated Staphylococcus aureus infections in children: a multicenter retrospective study in France. J Hosp Infect. 2024 Jun 14:S0195-6701(24)00206-8. doi: 10.1016/j.jhin.2024.04.030. Epub ahead of print. PMID: 38880286.