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Salvage of Central Venous Catheter Often Successful in Children With CLABSI

NEW YORK (Reuters Health) – Central venous catheter (CVC) salvage is often attempted and successful in ambulatory children presenting with central-line-associated bloodstream infections (CLABSIs), according to a new study.

“Many children leave the hospital with central venous catheters, and it is crucial that we focus more research on this vulnerable group. A major takeaway from this study is that ambulatory catheter salvage is successful three-quarters of the time in children, more often than previously reported inpatient catheter-salvage success rates,” Dr. Michael Rinke of the Children’s Hospital at Montefiore and Albert Einstein College of Medicine, in New York City, told Reuters Health by email.

Children with cancer, intestinal failure or other conditions may require long-term venous access, rendering them vulnerable to CLABSIs. The Infectious Disease Society of America (IDSA) recommends removing CVCs in cases of CLABSI with persistent bacteremia, severe illness, or causative organisms that are difficult to eradicate, such as Staphylococcus aureus, Pseudomonas aeruginosa, or Candida species.

However, clinicians must balance CVC removal with the difficulty of obtaining alternate access and subjecting patients to additional procedures, Dr. Rinke and colleagues note in a study scheduled for publication in Pediatrics.

In a five-year, multisite study, they evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. The analysis included 466 ambulatory CLABSIs in patients younger than age 22 years.

Attempted CVC salvage was defined as a CVC left in place three or more days after a positive blood culture result. Salvage failure was defined as removal of the CVC three or more days after CLABSI and successful salvage as treatment of CLABSI without CVC removal.

CVC salvage was attempted in 379 cases (82%) and was successful in 287 cases (76%), the team reports.

“Clinicians may want to lean more towards attempting ambulatory catheter salvage to prevent additional surgeries and complications in these kids who already spend too much time in hospitals and operating rooms,” Dr. Rinke told Reuters Health.

The study also reinforces the IDSA recommendation to remove CVCs in cases of CLABSI associated with Candida. “In our study population, only nine CLABSIs due to Candida resulted in attempted salvage, with salvage successful in only one case,” the researchers report.

“Children with Candida fungal blood infections or short-term central lines (PICC lines) were less likely to have successful catheter salvage. In those children, clinicians should more carefully weigh the risks and benefits of attempting ambulatory catheter salvage,” Dr. Rinke said.

SOURCE: Pediatrics, released November 17, 2021.

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