693. Compliance or Complication: Central Venous Catheter Management in Immunocompromised Children with Bloodstream Infections
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Hecht_Poster_IDWeek.2016.pdf (772.7 kB)
  • Background: Immunocompromised children (ICC) with long-term central venous catheters or ports (CVCP) are at increased risk for bloodstream infections (BSI). National guidelines recommend CVCP removal when BSI are caused by certain pathogens, however compliance is unknown.

    Methods: Retrospective cohort analysis of ICC (age ≤ 21 years) with CVCP hospitalized from 1/2009-12/2015 with BSI due to Staphylococcus aureus, Pseudomonas spp., Enterococcus spp. or Candida spp. Relapse and recurrence were defined as isolation of the same pathogen from CVCP blood cultures at <14d and 14-60d, respectively from the date of the initial BSI. Demographic, clinical, laboratory, and outcome data were recorded.

    Results: Fifty-three children (median age 6.2 y, range 0.5-21 y) had 108 BSI episodes requiring 84 hospitalizations. Underlying medical conditions included malignancy (n=18, 34%), bone marrow (n=16, 30%) or solid organ transplant (n=4, 8%) recipients, and need for therapies via CVCP (n=15 (28%): biologics, hemodialysis or parenteral nutrition). Results are summarized in Table 1. All patients received appropriate antimicrobial therapy for a median of 14d [range 11-17d]. Antibiotic lock therapy was administered in 12 (19%) and ethanol lock in 4 (6%) episodes of retained CVCP.

    Conclusion: Despite national guidelines, the majority of CVCP were retained in our cohort of ICC. A 1.5-fold increase in complication rates was observed in patients with retained CVCP, with no mortality observed in those with CVCP removal. This data supports the need for CVCP removal, particularly in ICC with BSI from Candida spp. and Pseudomonas spp.

    Table 1

    CVCP removal

    n=45 (42%)

    CVCP retained

    n=63 (58%)

    Candida spp.

    17 (68%)

    8 (32%)

    Staphylococcus aureus

    methicillin resistant, n (%)

    methicillin susceptible, n (%)

    12 (40%)

    6 (20%)

    6 (20%)

    18 (60%)

    6 (20%)

    12 (40%)

    Enterococcus spp.

    vancomycin resistant, n (%)

    10 (33%)

    2 (7%)

    20 (66%)

    1 (3%)

    Pseudomonas spp.

    6 (24%)

    17 (76%)

    Complicated BSI, n (%)

    3 (7%)

    0

    Complications, n (%)

    8 (18%)

    17 (27%)

    Relapse

    0

    2 (3%)

    Recurrence

    8 (18%)

    8 (13%)

    Death*

    0

    7 (11%)

    *7 infections resulting in 6 deaths: Candida spp. (3), Pseudomonas spp. (2), polymicrobial (1, Candida spp. and Pseudomonas spp.)

    Shaina Hecht, MD, Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH, Christopher Ouellette, MD, Pediatrics, Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH and Monica I. Ardura, DO, MSCS, Pediatrics, Infectious Diseases and Immunology, Host Defense Program, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH

    Disclosures:

    S. Hecht, None

    C. Ouellette, None

    M. I. Ardura, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.