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Initial Blood Cultures In Pediatric Patients With Central Line Infections And Short Bowel Syndrome Can Direct A Treatment Plan That Can Reduce Hospital Length Of Stay
*Michelle C Coughlin, *Elika Ridelman, *Joseph L Lelli, *Christina M Shanti
Wayne State University, Detroit, MI

OBJECTIVE(S):
Children with Short Bowel Syndrome (SBS) requiring parenteral nutrition are at high risk for recurrent central line-associated bloodstream infections (CLABSI) requiring inpatient admission. Predicting their response to treatment at admission could help revise our current treatment algorithm reducing their length of stay (LOS).
METHODS:
We conducted a retrospective study of all Intestinal Rehabilitation Clinic patients admitted for CLABSI at our academic hospital from January 2018 to June 2021. 24 patients met inclusion criteria. Demographic, blood culture and treatment response data were analyzed.
RESULTS:
There were 180 separate admissions for CLABSIs, with an average LOS of 9.4 days. 77.1% of admissions exceeded expected LOS. Admission outcome breakdown is demonstrated in figure 1. All patients were treated by a standard protocol. On initial cultures 64.4% grew a single bacteria, 10.6% a single fungus and 25% multiple organisms. 73.3% of single bacterial infections had a single positive culture. 78.9% of fungal infections and 48.9% of multiple organism infections had multiple positive cultures. All positive repeat cultures were treated with an ethanol lock (ETOH) for 24 hours then continued treatment. 91.1% of the catheters were preserved with this treatment algorithm. 8.9% of catheters required removal. Admission heart rate, temperature, and white count showed no significant difference between groups.
CONCLUSIONS:
SBS patients admitted for CLABSI with initial cultures growing fungal or multiple organisms frequently had multiple positive cultures while those with a single bacterial organism did not. Discharging patients who grow a single bacterial organism and placing an initial ethanol lock on those with multiple or fungal organisms could lead to a reduced average LOS, although some would require readmission for line removal. Revising our current treatment algorithm may have resulted in an average length of stay for these patients of 2.4 days saving approximately 1,200 patient hospital days, assuming no other influencing factors complicated admission.


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