Key result
Central line replacement following infection in pediatric pulmonary hypertension patients did not improve time to next infection compared to line salvage.
Why the study?
Does central line salvage compared to replacement improve reinfection rates in pediatric pulmonary hypertension patients receiving intravenous prostanoid therapy?
Cohort (n=40)
No
Does central line salvage compared to replacement improve reinfection rates in pediatric pulmonary hypertension patients receiving intravenous prostanoid therapy?
Central line salvage following bloodstream infections in pediatric pulmonary hypertension patients on IV prostanoids does not worsen reinfection rates compared to line replacement, potentially avoiding the risk of losing vascular access.
Answers are grounded in this paper and cite their sources.
Line salvage after central line infection yields similar reinfection rates to replacement in pediatric PH; leaves open whether salvage reduces procedural risks.
Treatment of pediatric pulmonary hypertension (PH) with IV prostanoids has greatly improved outcomes but requires a central line, posing inherent infection risk. This study examines the types of infections, infection rates, and importantly the effect of line management strategies on reinfection in children receiving IV prostanoids for PH. This study is a retrospective review of all pediatric PH patients receiving intravenous epoprostenol (EPO) or treprostinil (TRE) at one academic tertiary care center between 2000 and 2014. No patients declined participation in the study or were otherwise excluded. Infectious complications were characterized by organism(s), infection rates, time to next infection, and line management decisions (salvage vs. replace). Of the 40 patients followed, 13 sustained 38 infections involving 49 pathogens, with a predominance of gram-positive (GP) organisms (n = 35). The pooled infection rate was 1.06 per 1000 prostanoid days with no difference between EPO and TRE. No significant difference in reinfection rate was observed when comparing line salvage to replacement, regardless of organism type. Both overall and organism-type comparisons suggest longer time between line infections following line salvage compared with line replacement (732 vs. 410 days overall; 793 vs. 363 days for GP; 611 vs. 581 days for gram-negative [GN]; P > 0.05 for all comparisons). Central line replacement following blood stream infections in pediatric PH patients does not improve subsequent infection rates or time to next infection, and may lead to unnecessary risks associated with line replacement, including potential loss of vascular access. A revised approach to central line infections in pediatric PH is proposed.
No takes yet. Share an insight, caveat, or question.
McCarthy et al. (2018) conducted a cohort in Pediatric pulmonary hypertension (n=40). Central line replacement vs. Line salvage was evaluated on Time to next infection (days) (p=> 0.05). Central line replacement following infection in pediatric pulmonary hypertension patients did not improve time to next infection compared to line salvage.
Synapse has enriched 10 related papers. Consider them for comparative context: