180. Clinical course and risk factors for intravascular catheter-related bacteremia in children with intestinal failure
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ID week IF poster modified.pdf (138.5 kB)
  • Background:

    Children with intestinal failure often have repeated intravascular catheter related bacteremia (IVCRB). The purpose of this study was to prospectively study the incidence and clinical course of IVCRB and to look for modifiable risk factors. 

    Methods:

    Children with intestinal failure were enrolled and data collected monthly Oct 2007 thorugh August 2011. Contaminated blood cultures were defined as a single positive blood culture that did not recur despite the child receiving < 48 hours of effective antimicrobials. Potential risk factors for IVCRB were compared in months when children had IVCRB to months when they did not. 

    Results:

    All 16 eligible children were enrolled and followed for a combined total of 219 months (range 1 to 46 months; median 8 months). The etiology of intestinal failure was necrotizing enterocolitis (N=7), volvulus of other type of congenital obstruction (N=2), gastroschisis with or without intestinal atresia (N= 6), and lymphangiectasia (N=1). 

    145 positive blood cultures were obtained from 39 episodes in 10 different children. These were classified as contamination (N=7), bacteremia not due to IVCRB (N=1) and IVCRB (N=31) for an IVCRB rate of 4.6 per 1000 catheter days. The number of pathogens in IVCRB was 1 (N=17), 2 (N=12) and 3 (N=2). Symptoms were fever alone (N=13), fever and irritability (N=5), fever and lethargy (N=4), fever and decreased tolerance of oral feeds (N=4), and fever, irritability, decreased tolerance for feeds (N=1), lethargy alone (N=1) and no symptoms with cultures sent as follow-up of a previous IVCRB (N=2) or as stool contaminated the intravascular catheter (N=1). CRP was measured prior to antibiotics for 16 of the 31 IVCRBs and ranged from 0.3 to 151 mg/L ( mean 65). CRP was < 12 mg/L in 2 of the asymptomatic children and in one other child.

    For the 17 IVCRBs  where the intravascular catheter was successfully retained, antibiotics to which the pathogen was susceptible were continued for a median of 12 days. There were no serious complications. Risk factors for IVCRB were jugular location of the catheter and higher dose of intralipid. 

    Conclusion: Polymicrobial IVCRB  is common in intestinal failure. The intravascular catheter can be retained the  majority of the time with < 14 days antibiotics. Jugular intravascular catheters should be avoided.

    Joan Robinson, MD1, Linda Casey, MD2, Hien Huynh, MD1 and Donald Spady, MD1, (1)University of Alberta, Edmonton, AB, Canada, (2)University of British Columbia, Vancouver, BC, Canada

    Disclosures:

    J. Robinson, None

    L. Casey, None

    H. Huynh, None

    D. Spady, None

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