Objectives and Study Preserving venous access in children with intestinal failure (IF) requiring long-term parental nutrition (PN) can be critical for patient survival. Data regarding salvage of central venous catheter (CVC) after a catheter-related blood stream infection (CRBSI) in children are limited. We aimed to determine the incidence of CRBSI and rates of CVC salvage in children receiving home PN for IF.

Methods We searched our prospective PN database for the records of all CRBSI in children receiving home PN from January 2015 to April 2019. All the patients were at home with care by parents formally trained to connect, disconnect and manage PN. They all had shared care set up between our IF rehabilitation service and their local hospital. Data abstracted from the medical records included demographics, underlying disease, CRBSI number per patient, microorganism(s) isolated and CRBSI outcome. The CRBSI incidence and rates of catheter salvage were determined Children with immunodeficiencies were excluded. Diagnosis of CRBSI was based on clinical manifestations of infection such as fever, rigors, and/or hypotension and a positive blood cultures obtained via CVC in the absence of other potential sources of infection. CVC were removed if severe, potentially life-threatening symptoms occurred. The incidence of CRBSI was measured as number of catheter-related episodes per 1000/catheter days.

Results A total of 58 children (26 male, aged 7.2±4.6 years) were reviewed. The indications for PN were motility disorder in 44.8%, short bowel syndrome in 36.2% and enteropathy in 19%. The catheters used were single-lumen tunneled Hickmann (82/108), double-lumen (26/108), peripheral inserted central catheter (2/108) and Broviac (1/108).

Thirty-one of 58 (53.4%; 15 M, aged 5.8±4.3 years) children developed 108 CRBSIs over the study period. The median (range) number of CRBSI episodes per patient was 1 (0–14). The overall catheter days was 58414 and the CRBSI rate was 1.85/1000 catheter days.

Only 23 (21.3%) catheters were removed because of life-threatening symptoms and 85 (78.7%) of catheters were salvaged and retained despite CRBSI.

By organism, 38% were gram positive, 34.2% gram negative, 21.2% polymicrobial and 6.5% fungal CRBSI. The most frequent gram positive and negative organism was Staphylococcus aureus (31.7%) and Klebsiella species (43.2%) respectively. Catheter infected with gram positive bacteria showed the highest rate of CVC salvage (gram positive 92.7%, 78.2% polymicrobial, 67.6% gram negative, 57.1% fungal infection; P<0.05).

The CRBSI rate for double-lumen catheters was significantly greater than single-lumen catheters (24.1% vs 4.8%; P<0.0001). Patients with a double-lumen CVC were found to be at increased risk for CRBSI development (HR 2.51; [95% CI 1.70–3.86]; P <0.01).

Conclusion CVC is possible in more than three-quarters of CRBSIs in children on long-term home PN for IF. Successful salvage may depend on the species isolated. CRBSIs caused by gram positive bacteria, the most bacteria causing CRBSI, had a CVC salvage rate approaching 93%. Effective antibiotic treatment without removal of the CVC should be considered as first line treatment. A single-lumen CVC should be the catheter of first choice. Further studies to identify predictive factors of catheter removal after CRBSI are required.