Corkum Kristine S, Jones Rachel E, Reuter Caroline H, Kociolek Larry K, Morgan Elaine, Lautz Timothy B
Feinberg School of Medicine, Northwestern University, Chicago, USA.
Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
Pediatr Surg Int. 2017 Nov;33(11):1201-1207. doi: 10.1007/s00383-017-4165-5. Epub 2017 Sep 25.
Prompt central venous catheter (CVC) removal is currently recommended in children with Staphylococcus aureus central line-associated bloodstream infection (CLABSI). Our objective was to examine the outcome of attempted line salvage in children with S. aureus CLABSI and assess predictors of success.
A single-institution, retrospective cohort study was performed of all children with S. aureus CLABSI between 2012 and 2015. Patients with and without immediate CVC removal (≤ 2 days after first positive culture) were compared. The primary outcome was failed CVC salvage (removal after 3+ days).
Seventy-seven children met criteria for S. aureus CLABSI. Immediate CVC removal was performed in 27.3% of patients. Among the 72.7% patients in whom CVC salvage was attempted, 78.6% were successful and 21.4% required delayed CVC removal. Malignancy, short gut syndrome, neutropenia, methicillin-resistant S. aureus, and line type were not associated with salvage failure. No associated morbidity or mortality occurred in patients with a failed salvage attempt. New or recurrent bacteremia occurred in five patients, but three were successfully salvaged a second time.
CVC salvage was feasible in the majority of children with S. aureus CLABSI and was not associated with significant complications or attributable mortality as reported in adults.
目前建议对金黄色葡萄球菌中心静脉导管相关血流感染（CLABSI）患儿迅速拔除中心静脉导管（CVC）。我们的目的是研究金黄色葡萄球菌CLABSI患儿尝试保留导管的结果，并评估成功的预测因素。
对2012年至2015年间所有金黄色葡萄球菌CLABSI患儿进行单机构回顾性队列研究。比较立即拔除CVC（首次阳性培养后≤2天）和未立即拔除CVC的患者。主要结局是CVC保留失败（3天以上后拔除）。
77名儿童符合金黄色葡萄球菌CLABSI标准。27.3%的患者立即拔除了CVC。在72.7%尝试保留CVC的患者中，78.6%成功，21.4%需要延迟拔除CVC。恶性肿瘤、短肠综合征、中性粒细胞减少、耐甲氧西林金黄色葡萄球菌和导管类型与保留失败无关。保留尝试失败的患者未发生相关的发病率或死亡率。5例患者出现新的或复发性菌血症，但3例第二次成功保留导管。
大多数金黄色葡萄球菌CLABSI患儿保留CVC是可行的，且与成人报道的严重并发症或归因死亡率无关。
