Pediatric central line-associated bloodstream infections management: A retrospective study

Background Managing central-line-associated bloodstream infections (CLABSI) in children with long-term central venous catheters (CVC) is challenging. Catheter salvage strategy (CSS) can be attempted when intravenous therapy is essential. Methods A retrospective cohort study at a tertiary-care paediatric hospital evaluated CLABSI management and compared outcomes between CSS and CVC removal, including all children with CLABSI from January 2021 to June 2024. CSS was defined as CVC retention for ≥ 72 hours after starting empiric antibiotic therapy. Outcomes assessed included fever and bacteraemia persistence at 72 hours, hospital stay, complications, recurrence within 60 days, and treatment failure. Results Among 111 CLABSI episodes (23 short-term, 88 long-term CVCs) early CVC removal was applied in 18.9%. CSS occurred in 88.6% of long-term CLABSIs. Early removal was associated with non-tunnelled CVCs, multi-lumen CVCs, and Candida spp. or Staphylococcus aureus CLABSI. CSS was associated with oncological patients and/or stem-cell transplant recipients. CSS achieved a 61.4% success rate without significant differences in treatment success between CSS and early CVC removal groups, nor across different pathogens. Conclusions CSS was widely used with a success rate of 61.4% without differences across pathogens. Further studies are needed to define CSS's role in children according to the aetiology and patient characteristics.