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G389 Charting the rise of Gram negative organisms in Children with recurrent central line associated blood stream infections
  1. DJB Keene1,
  2. C Hughes-Day1,
  3. L Stephens2,
  4. S Almond2,
  5. D Sanyal3,
  6. S Paulus4,
  7. J Minford1
  1. 1Paediatric Surgery, Alder Hey Children’s Hospital, Liverpool, UK
  2. 2Paediatric Surgery, Royal Manchester Children’s Hospital, Manchester, UK
  3. 3Microbiology, Royal Manchester Children’s Hospital, Manchester, UK
  4. 4Infectious Diseases, Alder Hey Children’s Hospital, Liverpool, UK

Abstract

Aims Long-term tunnelled central venous catheters deliver potentially toxic medications such as chemotherapy and parenteral nutrition. Recurrent central line associated bloodstream infections (CLASBI) are a potentially serious complication. Introduction of central line care bundles can dramatically reduce paediatric CLABSI rates (Wheeler et al., Paediatrics 2011), however despite these interventions some patients develop recurrent CLABSIs. This study reports the recurrent CLABSI rate and organisms found in two regional paediatric hospitals.

Methods Paediatric patients diagnosed with a CLABSI between January 2012 and December 2012 were identified retrospectively in two regional paediatric institutions. All subsequent infection and line events were recorded for these patients. CLABSIs were classified according to the Centres for Disease Control and Prevention definition. Line event data was verified by comparing theatre records, clinic and discharge letters and radiology images.

Results Eighty seven patients were included in the study (44 patients from centre 1, 43 patients from centre 2). 165 CLABSIs were diagnosed during the study period (87 first CLABSI and 78 subsequent CLABSIs). Forty three patients (50%) developed a second CLABSI. And 22 (25%) developed a third CLABSI.

The median number of line days from 1st CLABSI per patient was 389 days in centre 1 and 188 days in centre 2.

112 CLABSIs were due to a Gram negative pathogen (68%). 44 CLABSIs were due to a Gram positive (27%) pathogen. 9 CLABSIs were due to fungi (5%). The overall recurrent CLABSI rate after one CLABSI was 4.2 per 1000 catheter days (3.3 per 1000 catheter days in centre 1, 5.1 per 1000 catheter days in centre 2). Repeat infections with identical pathogens occurred on 16 occasions. The most commonly identified organisms were Enterococcus faecalis (29), Escherischia coli (27), Klebsiella pneumoniae (23), Staphylococcus epidermidis (21), Staphylococcus aureus (12).

Conclusion Patients who develop one CLABSI are at high risk of recurrent catheter associated sepsis.

Gram negative organisms are the most frequently identified group of pathogens.

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