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PEDIATRICS Vol. 111 No. 3 March 2003, pp. e269-e274

ELECTRONIC ARTICLE

Central Venous Catheter Removal Versus In Situ Treatment in Neonates With Enterobacteriaceae Bacteremia

Kellie J. Nazemi, MD*, E. Stephen Buescher, MD*, Robert E. Kelly, Jr, MD{ddagger} and M. Gary Karlowicz, MD*

* Departments of *Pediatrics
{ddagger} Surgery, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk, Virginia

--> Objective. To determine how often neonates with Enterobacteriaceae (ENTB) bacteremia can be treated successfully without removing central venous catheters (CVCs).

Methods. A retrospective cohort study was conducted of ENTB bacteremia and CVCs in infants in a neonatal intensive care unit during a 7-year period (1994–2000). Cases of ENTB bacteremia were identified from a microbiology database and limited to late-onset cases occurring after 3 days of age.

Results. There were 53 cases of ENTB bacteremia in infants with CVCs. Blood cultures were positive for ENTB within a median of 10 hours (range: 5–43). Timing of CVC removal was at the discretion of attending neonatologists. Fifteen cases had early-removal CVC (ER-CVC) within 2 days, and 38 cases had late-removal CVC (LR-CVC) >2 days after the first positive blood culture for ENTB. There were no significant differences between infants in the ER-CVC and LR-CVC groups for case fatality, recurrence, or duration of ENTB bacteremia. Although 16 (42%) of 38 (95% confidence interval [CI]: 26%–59%) LR-CVC cases required CVC removal to resolve ENTB bacteremia, 17 (45%) of 38 (95% CI: 29%–62%) LR-CVC cases were treated successfully without removal of CVCs. ENTB bacteremia was successfully treated without CVC removal in 85% of 13 LR-CVC cases with 1 day of bacteremia in contrast to 24% of 25 LR-CVC cases with >1 day of bacteremia (relative risk: 3.5; 95% CI: 1.7–7.4). CVC removal was required to resolve ENTB bacteremia in 9 (82%) of 11 LR-CVC cases with severe thrombocytopenia compared with 7 (32%) of 22 LR-CVC cases without severe thrombocytopenia (relative risk: 2.6; 95% CI: 1.3–5.0).

Conclusions. Retention of CVCs was successful in 45% of cases of ENTB bacteremia in which it was attempted, but success was unlikely when bacteremia lasted >1 day. ENTB bacteremia cases associated with severe thrombocytopenia rarely resolved unless CVCs were removed.

Key Words: Enterobacteriaceae • central venous catheter • infant • newborn

Abbreviations: CVC, central venous catheter • ENTB, Enterobacteriaceae • NICU, neonatal intensive care unit • NTISS, Neonatal Therapeutic Intervention Scoring System • NEC, necrotizing enterocolitis • ER-CVC, early-removal central venous catheter • LR-CVC, late-removal central venous catheter • RR, relative risk • CI, confidence interval • ESBL, extended-spectrum beta-lactamase • NS, not significant

Received for publication Aug 29, 2002; Accepted Nov 11, 2002.




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