AUTHOR=Alby-Laurent Fanny , Lambe Cécile , Ferroni Agnès , Salvi Nadège , Lebeaux David , Le Gouëz Morgane , Castelle Martin , Moulin Florence , Nassif Xavier , Lortholary Olivier , Chalumeau Martin , Toubiana Julie 

TITLE=Salvage Strategy for Long-Term Central Venous Catheter-Associated Staphylococcus aureus Infections in Children

JOURNAL=Frontiers in Pediatrics

VOLUME=6

YEAR=2019

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2018.00427

DOI=10.3389/fped.2018.00427

ISSN=2296-2360

ABSTRACT=<p><bold>Introduction:</bold> Current international guidelines strongly recommend catheter removal in case of <italic>S. aureus</italic> central line-associated bloodstream infection (CLASBI), but a catheter salvage strategy may be considered in children given age-related specificities. No data is available regarding the outcome of this strategy in children. This study aims to evaluate catheter salvage strategy in children with <italic>S. aureus</italic> CLABSI, and to determine treatment failure rates and associated risk factors.</p><p><bold>Methods:</bold> We retrospectively analyzed data for all children &lt;18 years having <italic>S. aureus</italic> CLABSI on a long-term central venous catheter in a tertiary hospital from 2010 to 2014. We defined catheter salvage strategy as a central venous catheter left in place ≥3 days after initiation of empiric treatment for suspected bacteremia, and catheter salvage strategy failure as the persistence or relapse of bacteremia with a <italic>S. aureus</italic> strain harboring the same antibiotic susceptibility pattern, or the occurrence or the worsening of local or systemic infectious complication between 72 h and 28 days after the first positive blood culture.</p><p><bold>Results:</bold> During the study period, 49 cases of <italic>S. aureus</italic> CLABSI on long-term central venous catheters were observed in 41 children (including 59% with long-term parenteral nutrition) and 6 (15%) isolates were resistant to methicillin. A catheter salvage strategy was chosen in 37/49 (76%) cases and failed in 12/37 (32%) cases. Initial presence of bloodstream co-infection, serum concentration of vancomycin under the targeted value and inadequate empiric treatment were significantly associated with catheter salvage therapy failure.</p><p><bold>Conclusions:</bold> The catheter salvage strategy of <italic>S. aureus</italic> CLABSI on a long-term central venous catheter was frequent in the studied hospital and failed only in one third of cases.</p>