B. D. Hosfield1, A. K. Bagwell2, R. J. Vandewalle1, A. P. Ladd1 1Indiana University School Of Medicine,Pediatric Surgery,Indianapolis, IN, USA 2Indiana University School Of Medicine,Indianapolis, IN, USA
Introduction: Children requiring long-term central venous access are at risk for catheter associated blood stream infections (CLABSI). Treatment of CLABSI requires either removal of the catheter or antimicrobial treatment to sterilize the catheter and bloodstream, which is again at risk for CLABSI development. The purpose of this study is to identify factors that predispose the development of a second CLABSI.
Methods: A single-center institutional database was queried from 1/1/2010 to 12/31/2016 for patients aged 0-18 years old with a tunneled central venous catheter (tCVC) and diagnosis of CLABSI. The studied cohort were patients who developed a second CLABSI from the same tCVC. Patients undergoing treatment for malignances or solid organ/hematologic transplants were excluded. Factors associated with the treatment of the index CLABSI and the recurrence were analyzed.
Results: Thirty-one patients treated for CLABSI met study criteria of developing a second CLABSI. The median age for original tCVC placement was 15 months (IQR 4.5-33 months). Twenty-six patients in the cohort (83.9%) had short bowel syndrome (SBS). Three additional patients with SBS were identified who could not treat their CLABSI with antibiotics (clearance rate of 89.7%). The median time from tCVC placement to first CLABSI was 67 days (IQR 32.5-125.5 days). Multivariate analysis revealed a significantly shorter length of time from tCVC placement to first CLABSI for patients with SBS versus other indications (59 vs. 161 days, respectively; p=0.012) when controlling for age, gender, and culture data. The median time between initial and recurrent CLABSI in the study group was 49 days (IQR 24.5-91 days). There was no difference in median days from first CLABSI to second CLABSI for patients with SBS versus other diagnosis (48.5 vs. 53 days, respectively; p=0.747). Patients with isolates of Staphylococcus Aureus at the first CLABSI had a significantly longer length of time from first to second CLABSI when compared to those with other bacteria isolates on initial CLABSI cultures (104 vs. 43 days; p=0.001).
Conclusion: Initial CLABSI appears to occur earlier in pediatric patients with SBS compared to other indications for tCVC placement. Additionally, CLABSI due to isolated Staphylococcal Aureus infections confer a longer time before CLABSI recurrence among those lines salvaged with intravenous antibiotics.