Salvage strategy for long-term central venous catheter-associated Staphylococcus aureus infections in children: a multi-centre retrospective study in France.

Autor: Devautour C; Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France., Poey N; Department of General Pediatrics and Infectious Diseases, Robert Debré University Hospital, AP-HP, Université Paris Cité, Paris, France., Lagier J; Department of Pediatrics, Hospices Civils de Lyon, Lyon, France., Launay E; Department of Pediatrics, CHU Nantes, Nantes, France., Cerdac A; Pediatric Emergency Medicine & Infectious Diseases, CHU Lille, Lille, France., Vergnaud N; Department of General Pediatrics, Trousseau University Hospital, AP-HP, Pierre et Marie Curie University, Sorbonne Paris, Paris, France., Berneau P; Department of Pediatrics, Centre Hospitalier de Rennes, Rennes, France., Parize P; Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France., Ferroni A; Department of Clinical Microbiology, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France., Tzaroukian L; Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen, France., Pinhas Y; Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France., Pinquier D; Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen, France., Lorrot M; Department of General Pediatrics, Trousseau University Hospital, AP-HP, Pierre et Marie Curie University, Sorbonne Paris, Paris, France., Dubos F; Pediatric Emergency Medicine & Infectious Diseases, CHU Lille, Lille, France., Caseris M; Department of General Pediatrics and Infectious Diseases, Robert Debré University Hospital, AP-HP, Université Paris Cité, Paris, France., Ouziel A; Department of Pediatrics, Hospices Civils de Lyon, Lyon, France., Chalumeau M; Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France., Cohen JF; Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France., Toubiana J; Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France. Electronic address: julie.toubiana@aphp.fr.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2024 Aug; Vol. 150, pp. 125-133. Date of Electronic Publication: 2024 Jun 14.
DOI: 10.1016/j.jhin.2024.04.030
Abstrakt: Objectives: Catheter removal is recommended in adults with Staphylococcus 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 eight French tertiary-care hospitals (2010-2018). CSS was defined as an LTCVC left in place ≥72 h after initiating empiric antibiotic treatment for suspected bacteraemia. Characteristics of patients were reviewed, and multi-variable logistic regression was performed to identify factors associated with CSS failure (i.e., persistence, recurrence or complications of bacteraemia).
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 bacteraemia (39 of 74 cases, 53%). Factors independently associated with CSS failure were: history of catheter infection (adjusted odds ratio (aOR) 3.18, 95% confidence interval (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 tunnelled-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.
(Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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