M. M. Nourian1, A. L. Schwartz1, A. Stevens1, E. R. Scaife1, B. T. Bucher1 1University Of Utah,Division Of Pediatric Surgery,Salt Lake City, UT, USA
Introduction:
The optimal time to reinsert Tunneled central venous catheters (tCVC) after a documented catheter related blood stream infection (CLABSI) is not well defined. In infants and children in particular, this leads to additional hospital stay and increased health care utilization. The goal of this study is to identify risk factors for children who develop persistent bacteremia after tCVC removal and therefore would not be a candidate for immediate tCVC replacement.
Methods:
We performed a retrospective cohort analysis of children with a tCVC associated CLABSI from the electronic medical records at a tertiary care children’s hospital from 2000-2016. All children with a tCVC (Broviac or Port-a-Cath) and documented CLABSI were included in our analysis. Our primary outcome was persistent bacteremia after removal of the tCVC as defined by positive blood cultures after tCVC removal. Salient patient demographic and clinical factors were extracted from the medical record. Statistical significance was defined as p<0.05.
Results:
From 2000-2016 there were 4,735 patients who had a tCVC placed. Of those patients 78 (1.6%) had a documented CLABSI and tCVC removed. The majority of patients were white (68%) and male (53%) with an average age of 6.5 years. Most of tCVC placed were Broviac catheters (82%) compared to Port-a-Cath, and the median (IQR) lifespan of the lines placed was 70 (30-167) days. The majority of patients had a history of malignancy (53%) and approximately 36% were treated with chemotherapy 30 days prior to the documented CLABSI. In addition, 42% of patients were placed on home TPN with a history of GI failure rate of 30%. The most common causative organism for a CLABSI was S. epidermidis (28%) followed by Pseudomonas species (15%). Sixteen patients (20%) had persistent bacteremia after line removal. Compared to patients who cleared the bacteremia, those with persistent bacteremia were similar in age, race, and history of malignancy. Patients with persistent bacteremia were more likely to have a history of GI Failure (57% vs 23%, p=0.01) and MRSA bacteremia (13% vs 0%, p=0.04). There was no significant difference between the cleared and persistent bacteremia in gram positive or negative, polymicrobial, or fungal CLABSIs. The majority (78%) of children required temporary CVC placement on average 3.9 days after removal of infected tCVC.
Conclusion:
We have identified several risk factors for persistent bacteremia after tCVC removal including history of GI failure and MRSA bacteremia. This study supports the practice of early replacement of tCVC after removal for bacteremia in low risk patients. Early replacement could save on average a minimum of 2-3 hospital days in infants and children with tCVC associated CLABSI.
