Central Venous Catheter Salvage in Ambulatory Central Line-Associated Bloodstream Infections
Guidelines for treatment of central line-associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In th...
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| Veröffentlicht in: | Pediatrics (Evanston) 2021-12, Vol.148 (6), p.1 |
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| creator | Ford, William J H Bundy, David G Oyeku, Suzette Heo, Moonseong Saiman, Lisa Rosenberg, Rebecca E DeLaMora, Patricia Rabin, Barbara Zachariah, Philip Mirhaji, Parsa Klein, Elizabeth Obaro-Best, Oghale Drasher, Michael Peshansky, Alexandre Rinke, Michael L |
| description | Guidelines for treatment of central line-associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure.
This study was a secondary analysis of 466 ambulatory CLABSIs in patients |
| doi_str_mv | 10.1542/peds.2020-042069 |
| format | Article |
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This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage.
A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage.
CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2020-042069</identifier><identifier>PMID: 34814175</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Adolescent ; Ambulatory Care ; Bacteremia ; Bacteremia - microbiology ; Bacteremia - therapy ; Blood culture ; Candidemia ; Candidemia - epidemiology ; Care and treatment ; Catheter-Related Infections - microbiology ; Catheter-Related Infections - therapy ; Catheterization, Central Venous - adverse effects ; Catheters ; Central venous catheters ; Central Venous Catheters - adverse effects ; Child ; Child, Preschool ; Complications and side effects ; Device Removal ; Diagnosis ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Newborn ; Male ; Malignancy ; Neutropenia ; Patients ; Pediatrics ; Regression Analysis ; Retrospective Studies ; Risk factors ; Salvage Therapy - methods ; Salvage Therapy - statistics & numerical data ; Time Factors ; Treatment Failure ; Treatment Outcome ; Young Adult</subject><ispartof>Pediatrics (Evanston), 2021-12, Vol.148 (6), p.1</ispartof><rights>Copyright © 2021 by the American Academy of Pediatrics.</rights><rights>COPYRIGHT 2021 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Dec 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-b2e3865425279d97129fffa13690dc5d029b18a1e2dd596fb016fe859a24bc303</citedby><cites>FETCH-LOGICAL-c365t-b2e3865425279d97129fffa13690dc5d029b18a1e2dd596fb016fe859a24bc303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34814175$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ford, William J H</creatorcontrib><creatorcontrib>Bundy, David G</creatorcontrib><creatorcontrib>Oyeku, Suzette</creatorcontrib><creatorcontrib>Heo, Moonseong</creatorcontrib><creatorcontrib>Saiman, Lisa</creatorcontrib><creatorcontrib>Rosenberg, Rebecca E</creatorcontrib><creatorcontrib>DeLaMora, Patricia</creatorcontrib><creatorcontrib>Rabin, Barbara</creatorcontrib><creatorcontrib>Zachariah, Philip</creatorcontrib><creatorcontrib>Mirhaji, Parsa</creatorcontrib><creatorcontrib>Klein, Elizabeth</creatorcontrib><creatorcontrib>Obaro-Best, Oghale</creatorcontrib><creatorcontrib>Drasher, Michael</creatorcontrib><creatorcontrib>Peshansky, Alexandre</creatorcontrib><creatorcontrib>Rinke, Michael L</creatorcontrib><title>Central Venous Catheter Salvage in Ambulatory Central Line-Associated Bloodstream Infections</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Guidelines for treatment of central line-associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure.
This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage.
A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage.
CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.</description><subject>Adolescent</subject><subject>Ambulatory Care</subject><subject>Bacteremia</subject><subject>Bacteremia - microbiology</subject><subject>Bacteremia - therapy</subject><subject>Blood culture</subject><subject>Candidemia</subject><subject>Candidemia - epidemiology</subject><subject>Care and treatment</subject><subject>Catheter-Related Infections - microbiology</subject><subject>Catheter-Related Infections - therapy</subject><subject>Catheterization, Central Venous - adverse effects</subject><subject>Catheters</subject><subject>Central venous catheters</subject><subject>Central Venous Catheters - adverse effects</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Complications and side effects</subject><subject>Device Removal</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Malignancy</subject><subject>Neutropenia</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Salvage Therapy - methods</subject><subject>Salvage Therapy - statistics & numerical data</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1r3DAURUVpSaZJ9l0VQzfZOH2SLctaTkzSBgay6McqIGTpeeogSxNJLs2_r80kXXT1Nudd7uUQ8oHCFeU1-3xAm64YMCihZtDIN2RDQbZlzQR_SzYAFS1rAH5K3qf0CAA1F-yEnFZ1S2sq-IY8dOhz1K74iT7Mqeh0_oUZY_FNu996j8Xoi-3Uz07nEJ-LV3o3eiy3KQUz6oy2uHYh2JQj6qm48wOaPAafzsm7QbuEFy_3jPy4vfnefS1391_uuu2uNFXDc9kzrNpm2cOZkFYKyuQwDJpWjQRruAUme9pqisxaLpuhB9oM2HKpWd2bCqozcnnMPcTwNGPKahqTQee0x2WUYg1QKUTbiAX99B_6GObol3Yr1VIuONCFKo_UXjtUozfBZ_yTTXAO96iW8t292graAggh11Q48iaGlCIO6hDHScdnRUGtptRqSq2m1NHU8vLxpcjcT2j_Pbyqqf4Cro6Nig</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Ford, William J H</creator><creator>Bundy, David G</creator><creator>Oyeku, Suzette</creator><creator>Heo, Moonseong</creator><creator>Saiman, Lisa</creator><creator>Rosenberg, Rebecca E</creator><creator>DeLaMora, Patricia</creator><creator>Rabin, Barbara</creator><creator>Zachariah, Philip</creator><creator>Mirhaji, Parsa</creator><creator>Klein, Elizabeth</creator><creator>Obaro-Best, Oghale</creator><creator>Drasher, Michael</creator><creator>Peshansky, Alexandre</creator><creator>Rinke, Michael L</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20211201</creationdate><title>Central Venous Catheter Salvage in Ambulatory Central Line-Associated Bloodstream Infections</title><author>Ford, William J H ; Bundy, David G ; Oyeku, Suzette ; Heo, Moonseong ; Saiman, Lisa ; Rosenberg, Rebecca E ; DeLaMora, Patricia ; Rabin, Barbara ; Zachariah, Philip ; Mirhaji, Parsa ; Klein, Elizabeth ; Obaro-Best, Oghale ; Drasher, Michael ; Peshansky, Alexandre ; Rinke, Michael L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-b2e3865425279d97129fffa13690dc5d029b18a1e2dd596fb016fe859a24bc303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Ambulatory Care</topic><topic>Bacteremia</topic><topic>Bacteremia - microbiology</topic><topic>Bacteremia - therapy</topic><topic>Blood culture</topic><topic>Candidemia</topic><topic>Candidemia - epidemiology</topic><topic>Care and treatment</topic><topic>Catheter-Related Infections - microbiology</topic><topic>Catheter-Related Infections - therapy</topic><topic>Catheterization, Central Venous - adverse effects</topic><topic>Catheters</topic><topic>Central venous catheters</topic><topic>Central Venous Catheters - adverse effects</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Complications and side effects</topic><topic>Device Removal</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Malignancy</topic><topic>Neutropenia</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Salvage Therapy - methods</topic><topic>Salvage Therapy - statistics & numerical data</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ford, William J H</creatorcontrib><creatorcontrib>Bundy, David G</creatorcontrib><creatorcontrib>Oyeku, Suzette</creatorcontrib><creatorcontrib>Heo, Moonseong</creatorcontrib><creatorcontrib>Saiman, Lisa</creatorcontrib><creatorcontrib>Rosenberg, Rebecca E</creatorcontrib><creatorcontrib>DeLaMora, Patricia</creatorcontrib><creatorcontrib>Rabin, Barbara</creatorcontrib><creatorcontrib>Zachariah, Philip</creatorcontrib><creatorcontrib>Mirhaji, Parsa</creatorcontrib><creatorcontrib>Klein, Elizabeth</creatorcontrib><creatorcontrib>Obaro-Best, Oghale</creatorcontrib><creatorcontrib>Drasher, Michael</creatorcontrib><creatorcontrib>Peshansky, Alexandre</creatorcontrib><creatorcontrib>Rinke, Michael L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ford, William J H</au><au>Bundy, David G</au><au>Oyeku, Suzette</au><au>Heo, Moonseong</au><au>Saiman, Lisa</au><au>Rosenberg, Rebecca E</au><au>DeLaMora, Patricia</au><au>Rabin, Barbara</au><au>Zachariah, Philip</au><au>Mirhaji, Parsa</au><au>Klein, Elizabeth</au><au>Obaro-Best, Oghale</au><au>Drasher, Michael</au><au>Peshansky, Alexandre</au><au>Rinke, Michael L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Central Venous Catheter Salvage in Ambulatory Central Line-Associated Bloodstream Infections</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>148</volume><issue>6</issue><spage>1</spage><pages>1-</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><abstract>Guidelines for treatment of central line-associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure.
This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage.
A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage.
CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>34814175</pmid><doi>10.1542/peds.2020-042069</doi></addata></record> |
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| subjects | Adolescent Ambulatory Care Bacteremia Bacteremia - microbiology Bacteremia - therapy Blood culture Candidemia Candidemia - epidemiology Care and treatment Catheter-Related Infections - microbiology Catheter-Related Infections - therapy Catheterization, Central Venous - adverse effects Catheters Central venous catheters Central Venous Catheters - adverse effects Child Child, Preschool Complications and side effects Device Removal Diagnosis Female Hospitals, Pediatric Humans Infant Infant, Newborn Male Malignancy Neutropenia Patients Pediatrics Regression Analysis Retrospective Studies Risk factors Salvage Therapy - methods Salvage Therapy - statistics & numerical data Time Factors Treatment Failure Treatment Outcome Young Adult |
| title | Central Venous Catheter Salvage in Ambulatory Central Line-Associated Bloodstream Infections |
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