Abstract：
OBJECTIVE: Catheter removal is recommended in adults with S. aureus central line-associated bloodstream infection (CLABSI) but is controversial in children with long-term central venous catheters (LTCVC). We evaluated the occurrence of catheter salvage strategy (CSS) in children with S. aureus LTCVC-associated CLABSI and assessed determinants of CSS failure.
METHODS: We retrospectively included children (<18 years) with an LTCVC and hospitalized with S. aureus CLABSI in 8 French tertiary care hospitals (2010-2018). CSS was defined as an LTCVC left in place ≥ 72 hours after initiating empiric antibiotic treatment for suspected bacteremia. Characteristics of patients were reviewed, and multivariable logistic regression was performed to identify factors associated with CSS failure (i.e., persistence, recurrence, or complications of bacteremia).
RESULTS: We included 273 episodes of S. aureus LTCVC-associated CLABSI. CSS was chosen in 194 out of 273 (71%) cases and failed in 74 of them (38%). The main type of CSS failure was the persistence of bacteremia (39 out of 74 cases, 53%). Factors independently associated with CSS failure were: history of catheter infection (adjusted odds ratio [aOR] 3.18, 95% confidence interval [95%CI] 1.38-7.36), CLABSI occurring on an implantable venous access device (aOR 7.61, 95%CI 1.98-29.20) when compared with tunneled-cuffed CVC, polymicrobial CLABSI (aOR 3.45, 95%CI 1.25-9.50), and severe sepsis at the initial stage of infection (aOR 4.46, 95%CI 1.18-16.82).
CONCLUSIONS: CSS was frequently chosen in children with S. aureus LTCVC-associated CLABSI, and failure occurred in one-third of cases. The identified risk factors may help clinicians identify children at risk for CSS failure.
METHODS: We retrospectively included children (<18 years) with an LTCVC and hospitalized with S. aureus CLABSI in 8 French tertiary care hospitals (2010-2018). CSS was defined as an LTCVC left in place ≥ 72 hours after initiating empiric antibiotic treatment for suspected bacteremia. Characteristics of patients were reviewed, and multivariable logistic regression was performed to identify factors associated with CSS failure (i.e., persistence, recurrence, or complications of bacteremia).
RESULTS: We included 273 episodes of S. aureus LTCVC-associated CLABSI. CSS was chosen in 194 out of 273 (71%) cases and failed in 74 of them (38%). The main type of CSS failure was the persistence of bacteremia (39 out of 74 cases, 53%). Factors independently associated with CSS failure were: history of catheter infection (adjusted odds ratio [aOR] 3.18, 95% confidence interval [95%CI] 1.38-7.36), CLABSI occurring on an implantable venous access device (aOR 7.61, 95%CI 1.98-29.20) when compared with tunneled-cuffed CVC, polymicrobial CLABSI (aOR 3.45, 95%CI 1.25-9.50), and severe sepsis at the initial stage of infection (aOR 4.46, 95%CI 1.18-16.82).
CONCLUSIONS: CSS was frequently chosen in children with S. aureus LTCVC-associated CLABSI, and failure occurred in one-third of cases. The identified risk factors may help clinicians identify children at risk for CSS failure.
摘要：
目的：对于患有金黄色葡萄球菌中心静脉导管相关性血流感染（CLABSI）的成人，建议拔除导管，但对于长期使用中心静脉导管（LTCVC）的儿童，存在争议。我们评估了患有金黄色葡萄球菌LTCVC相关CLABSI的儿童的导管抢救策略（CSS）的发生，并评估了CSS失败的决定因素。
方法：我们回顾性地纳入了法国8家三级保健医院（2010-2018年）的患有LTCVC和金黄色葡萄球菌CLABSI住院的儿童（<18岁）。CSS定义为在开始经验性抗生素治疗怀疑菌血症后≥72小时的LTCVC。回顾了患者的特征，并进行多变量逻辑回归以确定与CSS失败相关的因素(即，持久性,复发,或菌血症的并发症)。
结果：我们纳入了273例金黄色葡萄球菌LTCVC相关CLABSI。CSS在273例（71％）中的194例中被选中，其中74例（38％）失败。CSS失败的主要类型是持续的菌血症（74例中有39例，53%）。与CSS失败独立相关的因素是：导管感染史（调整比值比[aOR]3.18，95％置信区间[95CI]1.38-7.36），CLABSI发生在植入式静脉接入装置上(aOR7.61,95CI1.98-29.20),与带隧道的CVC相比,多微生物CLABSI（AOR3.45，95CI1.25-9.50），感染初期严重脓毒症（aOR4.46，95CI1.18-16.82）。
结论：在患有金黄色葡萄球菌LTCVC相关CLABSI的儿童中经常选择CSS，和失败发生在三分之一的案例。确定的风险因素可以帮助临床医生识别有CSS失败风险的儿童。
方法：我们回顾性地纳入了法国8家三级保健医院（2010-2018年）的患有LTCVC和金黄色葡萄球菌CLABSI住院的儿童（<18岁）。CSS定义为在开始经验性抗生素治疗怀疑菌血症后≥72小时的LTCVC。回顾了患者的特征，并进行多变量逻辑回归以确定与CSS失败相关的因素(即，持久性,复发,或菌血症的并发症)。
结果：我们纳入了273例金黄色葡萄球菌LTCVC相关CLABSI。CSS在273例（71％）中的194例中被选中，其中74例（38％）失败。CSS失败的主要类型是持续的菌血症（74例中有39例，53%）。与CSS失败独立相关的因素是：导管感染史（调整比值比[aOR]3.18，95％置信区间[95CI]1.38-7.36），CLABSI发生在植入式静脉接入装置上(aOR7.61,95CI1.98-29.20),与带隧道的CVC相比,多微生物CLABSI（AOR3.45，95CI1.25-9.50），感染初期严重脓毒症（aOR4.46，95CI1.18-16.82）。
结论：在患有金黄色葡萄球菌LTCVC相关CLABSI的儿童中经常选择CSS，和失败发生在三分之一的案例。确定的风险因素可以帮助临床医生识别有CSS失败风险的儿童。
