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Central venous catheter-associated bloodstream infections in children diagnosed with intestinal failure in Southern Israel

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Objectives

To study the clinical, epidemiological, and microbiological associations between intestinal failure (IF) and central line–associated infections (CLABSI) in patients with central vein catheters (CVCs) during 2005–2016.

Methods

We compared retrospectively CLABSI rates according to background disease, type of line access, pathogen distribution, and antibiotic susceptibilities.

Results

One hundred and fourteen children (64.1% < 4 years) were enrolled. Main diagnoses were persistent diarrhea (20, 17.5%), short bowel syndrome (13, 11.4%), continuous-TPN w/o diarrhea (11, 9.7%), very early–onset inflammatory bowel disease (VEO-IBD, 8, 7%), Hirschsprung’s disease (3, 2.6%), non-oncologic hematologic conditions (13, 11.4%), and other diseases (46, 40.4%). 152.749 catheter days were recorded; 71.1% had Hickman’s catheters. Two hundred and nine CLABSI episodes were recorded in 58 patients (82% with IF, 13.7 and 8.2/1000 catheter days in IF, and non-gastrointestinal conditions, P = 0.09). More CLABSI were recorded in continuous TPN vs. VEO-IBD or persistent diarrhea (38.8 vs.15.8 and 12.8/1000 catheter days, P < 0.004). Among patients with Hickman in jugular vein, highest CLBSI incidence was in continuous TPN, VEO-IBD, and persistent diarrhea (29.9, 15.84, and 12.49 episodes/1000 catheter days, respectively). CVCs were removed in 38.8% CLABSI. Two hundred and thirty-five pathogens were isolated (Enterobacteriaceae spp. in 39% of IF patients, mostly in persistent diarrhea and short bowel syndrome patients, 47.6% and 34.8%, respectively). Coagulase-negative Staphylococcus was the commonest pathogen in continuous TPN, VEO-IBD, and Hirschsprung’s (71.4%, 55.6% and 46.1%, respectively).

Conclusions

CLABSI rates in IF patients were among the highest reported. We reported a “hierarchy” in CLABSI incidence among patients with IF and showed that CLABSI incidence and etiology were different as function of background diseases and CVC insertion site.

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Author notes

  1. Raouf Nassar and Guy Hazan contributed equally to this work.

Authors and Affiliations

  1. Pediatric Division, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Be’er Sheva, Israel

    Raouf Nassar, Guy Hazan, Eugene Leibovitz, Isaac Lazar, Aya Khalaila & Yariv Fruchtman

  2. Pediatric Gastroenterology Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Be’er Sheva, Israel

    Galina Ling & Baruch Yerushalmi

Authors
  1. Raouf Nassar
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  2. Guy Hazan
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  3. Eugene Leibovitz
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  4. Galina Ling
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  5. Isaac Lazar
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  6. Aya Khalaila
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  7. Yariv Fruchtman
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  8. Baruch Yerushalmi
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Correspondence to Eugene Leibovitz.

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The authors declare that they have no conflict of interest.

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The research protocol was approved by the Ethics Committee of the Soroka University Medical Center.

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Retrospective research, informed consent not needed.

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Nassar, R., Hazan, G., Leibovitz, E. et al. Central venous catheter-associated bloodstream infections in children diagnosed with intestinal failure in Southern Israel. Eur J Clin Microbiol Infect Dis 39, 517–525 (2020). https://doi.org/10.1007/s10096-019-03753-2

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  • DOI: https://doi.org/10.1007/s10096-019-03753-2

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