Abstract：
BACKGROUND: Children with chronic IF require long-term home parenteral nutrition (HPN), administered through a central venous catheter. Catheter-related bloodstream infection (CRBSI) with Staphylococcus aureus is known to be a serious infection with a high mortality rate and risk of complications. A standardized protocol on the management of S aureus CRBSIs in children receiving HPN is lacking. The aim of this study is to evaluate the effectiveness and safety of the current management in an HPN expertise center in the Netherlands.
METHODS: We performed a retrospective descriptive cohort study between 2013 and 2022 on children 0-18 years of age with chronic IF requiring long-term HPN. Our primary outcomes were the incidence of S aureus CRBSI per 1000 catheter days, catheter salvage attempt rate, and successful catheter salvage rate. Our secondary outcomes included complications and mortality.
RESULTS: A total of 74 patients (39 male; 53%) were included, covering 327.8 catheter years. Twenty-eight patients (38%) had a total of 52 S aureus CRBSIs, with an incidence rate of 0.4 per 1000 catheter days. The catheter salvage attempt rate was 44% (23/52). The successful catheter salvage rate was 100%. No relapse occurred, and no removal was needed after catheter salvage. All complications that occurred were already present at admission before the decision to remove the catheter or not. No patients died because of an S aureus CRBSI.
CONCLUSIONS: Catheter salvage in S aureus CRBSIs in children receiving HPN can be attempted after careful consideration by a multidisciplinary team in an HPN expertise center.
METHODS: We performed a retrospective descriptive cohort study between 2013 and 2022 on children 0-18 years of age with chronic IF requiring long-term HPN. Our primary outcomes were the incidence of S aureus CRBSI per 1000 catheter days, catheter salvage attempt rate, and successful catheter salvage rate. Our secondary outcomes included complications and mortality.
RESULTS: A total of 74 patients (39 male; 53%) were included, covering 327.8 catheter years. Twenty-eight patients (38%) had a total of 52 S aureus CRBSIs, with an incidence rate of 0.4 per 1000 catheter days. The catheter salvage attempt rate was 44% (23/52). The successful catheter salvage rate was 100%. No relapse occurred, and no removal was needed after catheter salvage. All complications that occurred were already present at admission before the decision to remove the catheter or not. No patients died because of an S aureus CRBSI.
CONCLUSIONS: Catheter salvage in S aureus CRBSIs in children receiving HPN can be attempted after careful consideration by a multidisciplinary team in an HPN expertise center.
摘要：
背景：患有慢性IF的儿童需要长期的家庭肠外营养（HPN），通过中心静脉导管给药。已知金黄色葡萄球菌的导管相关血流感染（CRBSI）是一种严重的感染，死亡率高，并发症风险高。缺乏在接受HPN的儿童中管理金黄色葡萄球菌CRBSI的标准化方案。这项研究的目的是评估荷兰HPN专业知识中心当前管理的有效性和安全性。
方法：我们在2013年至2022年期间对0-18岁患有需要长期HPN的慢性IF的儿童进行了一项回顾性描述性队列研究。我们的主要结果是每1000个导管天的金黄色葡萄球菌CRBSI的发生率，导管抢救尝试率，和成功的导管抢救率。我们的次要结果包括并发症和死亡率。
结果：共纳入74例患者（男性39例；53%），涵盖327.8导管年。28例患者（38%）共有52例金黄色葡萄球菌CRBSI，发病率为0.4/1000导管天。导管抢救尝试率为44%(23/52)。导管抢救成功率为100%。没有复发,导管抢救后不需要拔除。在决定是否移除导管之前，所有发生的并发症在入院时已经存在。没有患者因金黄色葡萄球菌CRBSI而死亡。
结论：接受HPN的儿童金黄色葡萄球菌CRBSI的导管抢救可以在HPN专家中心的多学科小组仔细考虑后尝试。
方法：我们在2013年至2022年期间对0-18岁患有需要长期HPN的慢性IF的儿童进行了一项回顾性描述性队列研究。我们的主要结果是每1000个导管天的金黄色葡萄球菌CRBSI的发生率，导管抢救尝试率，和成功的导管抢救率。我们的次要结果包括并发症和死亡率。
结果：共纳入74例患者（男性39例；53%），涵盖327.8导管年。28例患者（38%）共有52例金黄色葡萄球菌CRBSI，发病率为0.4/1000导管天。导管抢救尝试率为44%(23/52)。导管抢救成功率为100%。没有复发,导管抢救后不需要拔除。在决定是否移除导管之前，所有发生的并发症在入院时已经存在。没有患者因金黄色葡萄球菌CRBSI而死亡。
结论：接受HPN的儿童金黄色葡萄球菌CRBSI的导管抢救可以在HPN专家中心的多学科小组仔细考虑后尝试。
