Strategies for catheter-related blood stream infection based on medical course in children receiving parenteral nutrition.
OBJECTIVE
The central venous catheter (CVC) is a useful device for patients requiring parenteral nutrition (PN). However, the risk for catheter-related blood stream infection (CRBSI) is always present. We analyzed the medical course pattern and considered the strategies against febrile events in patients with CVC.


METHODS
Nine patients receiving PN in our institute from January 2009 to December 2010 were reviewed. Statistical analysis was performed with the Mann-Whitney U test. A p value of <0.05 was considered statistically significant.


RESULTS
Eighty-four febrile events were observed. Fifty-six specimens had a positive blood culture, and 52 (93%) specimens were found to be positive in 48 h. The fever dissolved within 48 h in 76 (90%) events after our scheduled treatment. Between the positive and negative blood culture groups, no statistical difference was observed in the count of white blood cell (p = 0.15), the proportion of neutrophils (p = 0.11) and C-reactive protein (p = 0.64). None of the CVCs were removed because of failure to control infection.


CONCLUSIONS
We recommend the treatment for CRBSI be initiated when patients with CVC develop a high-grade fever, even before exact identification of the cause of infection. The treatment can be corrected after the re-evaluation at 48 h.
Department of Pediatric Surgery, Aichi Children's Health and Medical Center, 474-8710, 1-2 Osakada, Morioka-cho, Obu, Aichi, Japan. wsumida288gto@yahoo.co.jp
Wataru
W
Sumida
Yoshio
Y
Watanabe
Hidemi
H
Takasu
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification*; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D006801:Humans; D010289:Parenteral Nutrition, Total; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors
D000900:Anti-Bacterial Agents