Objectives: To study the clinical, epidemiological and microbiological associations between IF and CLABSI in hospitalized patients with CVCs.
Methods: We enrolled 114 children <18 years diagnosed with prolonged diarrhea (PD, 20 patients, 17.5%), short bowel syndrome (SBS, 13, 11.4%), continuous-TPN w/o diarrhea (C-TPN, 11, 9.6%), inflammatory bowel disease (IBD, 8, 7%), Hirschprung disease (3, 2.6%), non-oncologic hematologic conditions (13, 4%), other diseases (OD, 46, 40.4%).
Results: 152.749 catheter-days were recorded. Hickman’s catheters (HC) were inserted in 71.1% patients. Most CVCs were inserted in jugular and subclavian veins (52.6% and 31.6%, respectively). 209 CLABSI episodes were recorded in 58 patients (12.1/1000 catheter days, 13.7 in IF), mostly in patients <4 years (64.1%), with HC (88.5%) and with IF (82%). More CLABSI were recorded in C-TPN vs. IBD and PD patients (38.8 vs.15.8 and 12.8/1000 days, P<0.004). Among patients with HC in jugular vein, CLABSI episodes/1000 days were more frequent in C-TPN vs. PD, Hirschsprung, SBS and OD (P<0.002). CVCs were removed in 81/209 (38.8%) CLABSI. Overall, 235 pathogens were isolated. Enterobacteriaceae spp. were isolated in 39% of IF patients, most commonly in PD and SBS (47.6% and 34.8%, respectively). Coagulase-negative Staphylococcus was the most frequent pathogen in C-TPN, IBD and Hirschprung (71.4%, 55.6% and 46.1%, respectively). Enterobacteriaceae spp. susceptibility rates to meropenem, gentamicin and piperacillin/tazobactam were 100, 93% and 86%, respectively.
Conclusions: CLABSI rates in IF patients were among the highest reported in the medical literature. CLABSI incidence and etiology were different as function of background diseases and CVC insertion site.
