Prevention of catheter-related bacteremia in pediatric intestinal transplantation/short gut syndrome children with long-term central venous catheters

Ali Mirza Onder, Tomoaki Kato, Nancy Simon, Maria Rivera-Hernandez, Jayanthi Chandar, Brenda Montane, Denise Francoeur, Genaro Salvaggi, Andreas G. Tzakis, Gaston E Zilleruelo

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Catheter-related bacteremia (CRB), along with liver failure is the leading cause of mortality and morbidity in parenteral nutrition dependent children. Immunosuppressant therapy following transplantation increases the risk of CRB. Previous reports in pediatric cancer patients have described the use of antibiotic lock solutions (ABL) for prophylaxis of CRB. In our institution, we evaluated five children (ages between one and four yr old), three with intestinal transplantation and two with short gut syndrome, who were high risk for recurrent CRB defined by their incidence of bacteremias in the observation period (>2 CRB/six months or life-threatening CRB). These children received the prophylactic ABL protocol with tobramycin-tissue plasminogen activator, four h per day, on alternating ports for six to eight months. Each patient was his/her own historical control. We observed decreased incidence of CRB's (p < 0.05), days of hospitalization due to CRB's (p < 0.0001), the days of intensive care admissions due to CRB (p < 0.0001), as well as the total days of systemic antibiotic exposure (p < 0.001). Catheter survival during the ABL era was longer but not reaching statistical significance. There was no advantage in removing and later replacing the catheter to wire-guided exchange while on systemic antibiotics. One patient presented with break-through bacteremia, septic shock and died. None of the catheters were lost to occlusion/malfunction. ABL did not induce an increased resistance to tobramycin. These preliminary findings suggest that ABL can be used safely and effectively in parenteral nutrition dependent children with long-term central venous catheters.

Original languageEnglish
Pages (from-to)87-93
Number of pages7
JournalPediatric Transplantation
Volume11
Issue number1
DOIs
StatePublished - Feb 1 2007

Fingerprint

Central Venous Catheters
Bacteremia
Catheters
Transplantation
Pediatrics
Anti-Bacterial Agents
Tobramycin
Parenteral Nutrition
SHORT syndrome
Incidence
Liver Failure
Tissue Plasminogen Activator
Critical Care
Immunosuppressive Agents
Septic Shock
Hospitalization
Observation
Morbidity

Keywords

  • Antibiotic-lock solutions
  • Catheter survival
  • Catheter-related bacteremia
  • Parenteral nutrition
  • Prophylaxis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Prevention of catheter-related bacteremia in pediatric intestinal transplantation/short gut syndrome children with long-term central venous catheters. / Onder, Ali Mirza; Kato, Tomoaki; Simon, Nancy; Rivera-Hernandez, Maria; Chandar, Jayanthi; Montane, Brenda; Francoeur, Denise; Salvaggi, Genaro; Tzakis, Andreas G.; Zilleruelo, Gaston E.

In: Pediatric Transplantation, Vol. 11, No. 1, 01.02.2007, p. 87-93.

Research output: Contribution to journalArticle

Onder, AM, Kato, T, Simon, N, Rivera-Hernandez, M, Chandar, J, Montane, B, Francoeur, D, Salvaggi, G, Tzakis, AG & Zilleruelo, GE 2007, 'Prevention of catheter-related bacteremia in pediatric intestinal transplantation/short gut syndrome children with long-term central venous catheters', Pediatric Transplantation, vol. 11, no. 1, pp. 87-93. https://doi.org/10.1111/j.1399-3046.2006.00634.x
Onder, Ali Mirza ; Kato, Tomoaki ; Simon, Nancy ; Rivera-Hernandez, Maria ; Chandar, Jayanthi ; Montane, Brenda ; Francoeur, Denise ; Salvaggi, Genaro ; Tzakis, Andreas G. ; Zilleruelo, Gaston E. / Prevention of catheter-related bacteremia in pediatric intestinal transplantation/short gut syndrome children with long-term central venous catheters. In: Pediatric Transplantation. 2007 ; Vol. 11, No. 1. pp. 87-93.
@article{0e56674c2a8e498bb320b52a0b6b1038,
title = "Prevention of catheter-related bacteremia in pediatric intestinal transplantation/short gut syndrome children with long-term central venous catheters",
abstract = "Catheter-related bacteremia (CRB), along with liver failure is the leading cause of mortality and morbidity in parenteral nutrition dependent children. Immunosuppressant therapy following transplantation increases the risk of CRB. Previous reports in pediatric cancer patients have described the use of antibiotic lock solutions (ABL) for prophylaxis of CRB. In our institution, we evaluated five children (ages between one and four yr old), three with intestinal transplantation and two with short gut syndrome, who were high risk for recurrent CRB defined by their incidence of bacteremias in the observation period (>2 CRB/six months or life-threatening CRB). These children received the prophylactic ABL protocol with tobramycin-tissue plasminogen activator, four h per day, on alternating ports for six to eight months. Each patient was his/her own historical control. We observed decreased incidence of CRB's (p < 0.05), days of hospitalization due to CRB's (p < 0.0001), the days of intensive care admissions due to CRB (p < 0.0001), as well as the total days of systemic antibiotic exposure (p < 0.001). Catheter survival during the ABL era was longer but not reaching statistical significance. There was no advantage in removing and later replacing the catheter to wire-guided exchange while on systemic antibiotics. One patient presented with break-through bacteremia, septic shock and died. None of the catheters were lost to occlusion/malfunction. ABL did not induce an increased resistance to tobramycin. These preliminary findings suggest that ABL can be used safely and effectively in parenteral nutrition dependent children with long-term central venous catheters.",
keywords = "Antibiotic-lock solutions, Catheter survival, Catheter-related bacteremia, Parenteral nutrition, Prophylaxis",
author = "Onder, {Ali Mirza} and Tomoaki Kato and Nancy Simon and Maria Rivera-Hernandez and Jayanthi Chandar and Brenda Montane and Denise Francoeur and Genaro Salvaggi and Tzakis, {Andreas G.} and Zilleruelo, {Gaston E}",
year = "2007",
month = "2",
day = "1",
doi = "10.1111/j.1399-3046.2006.00634.x",
language = "English",
volume = "11",
pages = "87--93",
journal = "Pediatric Transplantation",
issn = "1397-3142",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Prevention of catheter-related bacteremia in pediatric intestinal transplantation/short gut syndrome children with long-term central venous catheters

AU - Onder, Ali Mirza

AU - Kato, Tomoaki

AU - Simon, Nancy

AU - Rivera-Hernandez, Maria

AU - Chandar, Jayanthi

AU - Montane, Brenda

AU - Francoeur, Denise

AU - Salvaggi, Genaro

AU - Tzakis, Andreas G.

AU - Zilleruelo, Gaston E

PY - 2007/2/1

Y1 - 2007/2/1

N2 - Catheter-related bacteremia (CRB), along with liver failure is the leading cause of mortality and morbidity in parenteral nutrition dependent children. Immunosuppressant therapy following transplantation increases the risk of CRB. Previous reports in pediatric cancer patients have described the use of antibiotic lock solutions (ABL) for prophylaxis of CRB. In our institution, we evaluated five children (ages between one and four yr old), three with intestinal transplantation and two with short gut syndrome, who were high risk for recurrent CRB defined by their incidence of bacteremias in the observation period (>2 CRB/six months or life-threatening CRB). These children received the prophylactic ABL protocol with tobramycin-tissue plasminogen activator, four h per day, on alternating ports for six to eight months. Each patient was his/her own historical control. We observed decreased incidence of CRB's (p < 0.05), days of hospitalization due to CRB's (p < 0.0001), the days of intensive care admissions due to CRB (p < 0.0001), as well as the total days of systemic antibiotic exposure (p < 0.001). Catheter survival during the ABL era was longer but not reaching statistical significance. There was no advantage in removing and later replacing the catheter to wire-guided exchange while on systemic antibiotics. One patient presented with break-through bacteremia, septic shock and died. None of the catheters were lost to occlusion/malfunction. ABL did not induce an increased resistance to tobramycin. These preliminary findings suggest that ABL can be used safely and effectively in parenteral nutrition dependent children with long-term central venous catheters.

AB - Catheter-related bacteremia (CRB), along with liver failure is the leading cause of mortality and morbidity in parenteral nutrition dependent children. Immunosuppressant therapy following transplantation increases the risk of CRB. Previous reports in pediatric cancer patients have described the use of antibiotic lock solutions (ABL) for prophylaxis of CRB. In our institution, we evaluated five children (ages between one and four yr old), three with intestinal transplantation and two with short gut syndrome, who were high risk for recurrent CRB defined by their incidence of bacteremias in the observation period (>2 CRB/six months or life-threatening CRB). These children received the prophylactic ABL protocol with tobramycin-tissue plasminogen activator, four h per day, on alternating ports for six to eight months. Each patient was his/her own historical control. We observed decreased incidence of CRB's (p < 0.05), days of hospitalization due to CRB's (p < 0.0001), the days of intensive care admissions due to CRB (p < 0.0001), as well as the total days of systemic antibiotic exposure (p < 0.001). Catheter survival during the ABL era was longer but not reaching statistical significance. There was no advantage in removing and later replacing the catheter to wire-guided exchange while on systemic antibiotics. One patient presented with break-through bacteremia, septic shock and died. None of the catheters were lost to occlusion/malfunction. ABL did not induce an increased resistance to tobramycin. These preliminary findings suggest that ABL can be used safely and effectively in parenteral nutrition dependent children with long-term central venous catheters.

KW - Antibiotic-lock solutions

KW - Catheter survival

KW - Catheter-related bacteremia

KW - Parenteral nutrition

KW - Prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=33846187239&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846187239&partnerID=8YFLogxK

U2 - 10.1111/j.1399-3046.2006.00634.x

DO - 10.1111/j.1399-3046.2006.00634.x

M3 - Article

C2 - 17239129

AN - SCOPUS:33846187239

VL - 11

SP - 87

EP - 93

JO - Pediatric Transplantation

JF - Pediatric Transplantation

SN - 1397-3142

IS - 1

ER -