Bloodstream Infections in Preterm Neonates and Mortality Associated Risk Factors

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

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Gram-negative bloodstream infections and sepsis: risk factors, screening tools and surveillance

British Medical Bulletin ◽

10.1093/bmb/ldz033 ◽

2019 ◽

Vol 132 (1) ◽

pp. 5-15

Author(s):

Eleanor Mitchell ◽

Mark S Pearce ◽

Anthony Roberts

Keyword(s):

Risk Factors ◽

Bloodstream Infections ◽

Screening Tools ◽

Topic Area ◽

Gram Negative ◽

Sepsis Risk ◽

Comorbidity Scores ◽

Associated Risk Factors ◽

The Uk ◽

Healthcare Associated

Abstract Introduction and background Incidence of gram-negative bloodstream infections (GNBSIs) and sepsis are rising in the UK. Healthcare-associated risk factors have been identified that increase the risk of infection and associated mortality. Current research is focused on identifying high-risk patients and improving the methods used for surveillance. Sources of data Comprehensive literature search of the topic area using PubMed (Medline). Government, professional and societal publications were also reviewed. Areas of agreement A range of healthcare-associated risk factors independently associate with the risk of GNBSIs and sepsis. Areas of controversy There are calls to move away from using simple comorbidity scores to predict the risk of sepsis-associated mortality, instead more advanced multimorbidity models should be considered. Growing points and areas for developing research Advanced risk models should be created and evaluated for their ability to predict sepsis-associated mortality. Investigations into the accuracy of NEWS2 to predict sepsis-associated mortality are required.

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Catheter-Related Bloodstream Infections in Children with Short Bowel Syndrome: A Single Center Retrospective Study

10.21203/rs.3.rs-38079/v1 ◽

2020 ◽

Author(s):

Chenling Yuan ◽

Xiaolu Li ◽

Hui Hu ◽

Dan Li ◽

Yongmei Xiao ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Short Bowel Syndrome ◽

Potential Risk ◽

Ileocecal Valve ◽

Bloodstream Infections ◽

Short Bowel ◽

Long Duration ◽

Potential Risk Factors ◽

Associated Risk Factors

Abstract Background: Pediatric short bowel syndrome (SBS) is a devastating clinical entity that is usually managed with parenteral nutrition (PN). Catheter-related bloodstream infection (CRBSI) is a serious complication of long-term PN. The aim of this study was to evaluate the incidence and risk factors of CRBSI in SBS children. Methods: Nineteen pediatric patients with SBS were retrospectively recruited from Shanghai Children’s Hospital between August 2015 and December 2019. Clinical data, including demographics, aetiology of SBS, site and type of catheters, duration of PN, comorbidities, and microbiological data regarding CRBSI, were collected and reviewed to assess the CRBSI incidence and associated risk factors. Results: A total of 57 catheter insertions for PN were administered in 19 SBS children. CRBSI was identified in 11 cases among 6 patients during a total catheter days of 1907. The rate of CRBSI was 5.8 per 1000 catheter days. The common manifestations of the SBS children with CRBSI were fever (6/11, 54.5%), lethargy (5/11, 45.4%), stagnation of weight (7/11, 63.6%), and increment of enterostomy fluid (7/11, 63.6%). Potential risk factors for CRBSI included an absence of ileocecal valve (p=0.046), and long duration of PN (p=0.019). The most common microorganism isolated from the blood cultures was Klebsiella pneumoniae (6/11, 54.55%). Conclusions: The rate of CRBSI was 5.8 per 1000 catheter days, and klebsiella pneumoniae was the most common isolated pathogen of CRBSI in the studied SBS children. An absence of ileocecal valve and long duration of PN were potential risk factors of CRBSI.

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