J. S. Graham1, M. Mathis2, L. Wilkinson2, S. Anderson2, C. Hutto3, K. Monroe4, A. Jones4, R. Dimmitt5, D. Galloway5, C. Martin2 1University of Alabama School of Medicine,Birmingham, AL, USA 2University of Alabama at Birmingham,Surgery/Pediatric Surgery,Birmingham, Alabama, USA 3University of Alabama at Birmingham,Infectious Disease/Pediatrics,Birmingham, Alabama, USA 4University of Alabama at Birmingham,Emergency Medicine/Pediatrics,Birmingham, Alabama, USA 5University of Alabama at Birmingham,Gastroenterology;Hepatology And Nutrition Services/Pediatrics,Birmingham, Alabama, USA
Introduction: Long-term parenteral nutrition administered by a central venous catheter (CVC) is often needed for pediatric patients with intestinal failure. Central line-associated bloodstream infections (CLABSIs) are a common cause of life-threatening bacteremia and sepsis in this patient population, secondary to long-term CVC use. When a parenteral nutrition (PN)-dependent patient presents with fever and other infection-concerning-symptoms, prompt recognition and care are needed. Expedited antimicrobial treatment has been shown to decrease mortality and morbidity in patients with sepsis.
Methods: A 36 month, IRB approved retrospective chart review was conducted on TPN-dependent patients with intestinal failure who present with a fever to Children’s of Alabama’s ED and were admitted to the hospital. Outcomes of interest were adherence to protocol, unplanned transfers, and length of stay.
Results: 44 patients were included in the study, 28 were in the first 18-month period and 26 were in the second, with 10 patients in both populations. Post-protocol implementation, mean time from ED admission to antibiotic ordered and ED admission to antibiotic administered were lower (2:17±1.34 vs. 0:46±0.46, p<0.001, and 2:46±1:42 vs. 1:19±0:49, p<0.001), mean time between antibiotic administration and admission to the floor was greater (2:37±1:02 vs. 1:56±1:25, p=0.025), number of infectious disease consultation was greater (23.5% vs. 46.7%, p=0.006), floor to ICU transfers were lower (28.6% vs. 6.5%, p=0.009), readmission within 30 days was greater (5.9% vs. 22.8%, p=0.009) and mean length of stay was similar (7.67±4.82 vs. 6.93±3.25, p=0.283).
Conclusion: Here we show the value and importance of expedited antimicrobial treatment and a multidisciplinary approach to the treatment of each patient. A prospective analysis of the patients being readmitted within 30 days is recommended to determine the source of increased infection incidences and readmission rates.?