Comparing Outcomes of Children with Central Line-Associated Bloodstream Infections due to Staphylococcus aureus Retained vs. Removed Central Line

Central venous catheters (CVCs) are essential devices allowing children with various medical conditions (e.g., cancer, gastrointestinal diseases) to receive life-saving medications and nutrition. CVCs, however, carry a significant risk for infection, which can lead to morbidity and mortality. The Infectious Diseases Society of America recommends CVC removal for patients, including children, with central line-associated bloodstream infection (CLABSI) caused by a variety of organisms, including Staphylococcus aureus. This recommendation is based on studies of adults in which the risk of hematologic complications is high. When a CVC is removed, children often require a general anesthetic which can have neurocognitive effects. Additionally, procedural complications including pneumothorax, arterial cannulation, and venous stenosis can occur. Given these challenges, as well as difficulties with vascular access in children, CVC salvage may be attempted.. We performed a retrospective single-institution cohort study of all children with S. aureus CLASBI infection between 2011 and 2021. Outcomes of patients with and without immediate CVC removal (<2 days after first positive blood culture) were compared. The purpose of this study is to review pediatric patients with S. aureus CLABSI to determine the feasibility of CVC salvage, identify predictors of CVC salvage failure, and to assess complications to attempted CVC salvage.