K. D. Nadendla1, M. Shroyer1, L. Wilkinson1, R. Dimmitt2, D. Galloway2, C. A. Martin1 1University Of Alabama at Birmingham,Pediatric Surgery/Surgery,Birmingham, Alabama, USA 2University Of Alabama at Birmingham,Gastroenterology/Pediatrics,Birmingham, Alabama, USA
Introduction: Life threatening central venous line (CVL) sepsis is a primary cause of mortality in patients with intestinal failure (IF). Current Infectious Diseases Society of America (IDSA) guidelines recommend CVL removal for bacteremia. However, many IF patients have limited venous access prompting initial attempts to salvage the line (non-removal of the CVL and antibiotic treatment). Here we describe predictors of line salvage at our institution, a topic which has been poorly understood historically.
Methods: The database for the Georgeson Center for Advanced Intestinal Rehabilitation (GCAIR) at the University of Alabama at Birmingham was queried from 2010-2015 to identify all patients with IF that were admitted for a CVL infection. Demographics and clinical parameters were compared among patients who underwent line removal to patients where the line was salvaged. Results were compared by a student’s unpaired T test.
Results:Forty patients were identified with 125 admissions for CVL infections. Line removal occurred in 71(56.8%) and 54(43.8%) successfully had their lines salvaged. The average age (months) for the removed group was 29.38 and 28.39 for the salvage group. Episodes of life threating sepsis were less frequent among the salvaged group as well as fungemia (p<0.0001). There was no significant difference in the non-fungal organisms cultured, location of the CVL, and number of previous admissions.
Conclusion:With the exception of cases of fungemia, line salvage of infected CVLs should be attempted in patients with IF when clinically possible. General pediatric CVL infection guidelines should be modified for patients with IF with limited venous access to address line salvaging methods.
