title: Prospective cohort study of the outcome of and risk factors for intravascular catheter-related bloodstream infections in children with intestinal failure.
abstract: BACKGROUND
  Children with intestinal failure (IF) have frequent catheter-related bloodstream infections (CRBSIs). The purpose of this study was to prospectively study the clinical course of CRBSIs and to seek modifiable risk factors for CRBSIs in children with IF.
  
  
  METHODS
  Children with IF were enrolled prospectively and data on potential risk factors collected monthly. Additional data were collected when they had CRBSIs.
  
  
  RESULTS
  Sixteen children were enrolled, yielding 223 months of data. The rate of CRBSIs was 4.6 per 1000 catheter days. The most consistent symptom at onset of CRBSI was fever (28 of 32 cases). Elevated C-reactive protein (CRP) was the only laboratory abnormality that was consistently associated with the onset of CRBSI (elevated in 15 of the 18 cases where it was measured). Combining all episodes in the cases that relapsed, the catheter salvage rate was 17 of 29 (59%), including 4 of 11 polymicrobial CRBSIs. Risk factors for CRBSI included double lumen tunneled central venous catheter (CVC), jugular placement of CVC, higher doses of intralipid, and having <50 cm small bowel postresection.
  
  
  CONCLUSIONS
  The diagnosis of CRBSI should be questioned in the absence of fever and/or elevated CRP. Salvage of catheters should be attempted with all bacterial CRBSIs, assuming that the child is stable since the CVC can be retained in the majority of cases.
authors.affiliation: Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada jr3@ualberta.ca.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Robinson
authors.affiliation: Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada British Columbia Children's Hospital, Vancouver, British Columbia.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Casey
authors.affiliation: Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Hien Q
authors.initials: HQ
authors.lastname: Huynh
authors.affiliation: Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Donald W
authors.initials: DW
authors.lastname: Spady
mesh_terms: D016470:Bacteremia / Q000209:etiology; D001419:Bacteria / Q000302:isolation & purification; D002097:C-Reactive Protein / Q000032:analysis; D055499:Catheter-Related Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology; D062905:Central Venous Catheters / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000150:complications / Q000451:nursing*; D007422:Intestines / Q000503:physiopathology; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods* / Q000451:nursing; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein
keywords: parenteral nutrition; pediatrics; sepsis