Weill Cornell Medicine, New York, New York.
Medical University of South Carolina, Charleston, South Carolina.
Pediatrics. 2021 Dec 1;148(6). doi: 10.1542/peds.2020-042069.
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.
针对中心静脉导管相关性血流感染（CLABSI）的治疗指南建议在许多情况下移除中心静脉导管（CVC）。临床医生必须在平衡这些建议与获得替代通路的困难以及让患者接受额外程序之间做出权衡。在这项研究中，我们评估了患有门诊 CLABSI 的儿科患者中 CVC 挽救的情况，并评估了与治疗失败相关的风险因素。
这是对 2010 年至 2015 年间 5 家儿科医疗中心收治的 466 例年龄<22 岁的门诊 CLABSI 患者的 466 例门诊 CLABSI 患者进行的二次分析。我们将尝试性 CVC 挽救定义为在血培养阳性后至少保留 CVC 3 天。挽救失败是指在 CLABSI 后至少 3 天移除 CVC。成功挽救是指无需移除 CVC 即可治疗 CLABSI。使用二变量和多变量逻辑回归分析来检验风险因素与尝试性和成功性挽救之间的关联。
共有 460 例门诊 CLABSI 纳入本分析。尝试了 379 例（82.3%）的 CVC 挽救。基础诊断、CVC 类型、管腔数量和无念珠菌血症与尝试性挽救相关。在 379 例尝试挽救的病例中，有 287 例（75.7%）成功挽救。基础诊断、CVC 类型、管腔数量和无念珠菌血症与成功挽救相关。在恶性肿瘤患者中，CLABSI 前 30 天内的中性粒细胞减少症与尝试性和成功性挽救均显著相关。
在患有门诊 CLABSI 的儿科患者中，经常尝试进行 CVC 挽救，且通常都很成功。
