BACKGROUND Guidelines for treatment of central line-associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

中文翻译：

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中心静脉导管在动态中心线相关血流感染中的抢救。

背景 中心静脉导管相关血流感染 (CLABSI) 的治疗指南建议在许多情况下移除中心静脉导管 (CVC)。临床医生必须在这些建议与获得替代通路和使患者接受额外程序的困难之间取得平衡。在这项研究中，我们评估了门诊 CLABSI 儿童患者的 CVC 挽救以及治疗失败的相关危险因素。方法 本研究是对 2010 年至 2015 年在 5 个儿科医疗中心就诊的 22 岁以下患者的 466 例动态 CLABSI 的二次分析。我们将尝试 CVC 抢救定义为 CVC 在血培养结果呈阳性后 3 天后留在原位。挽救失败是 CLABSI 后≥3 天移除 CVC。成功的补救措施是在不移除 CVC 的情况下治疗 CLABSI。双变量和多变量逻辑回归分析用于测试风险因素与尝试和成功抢救之间的关联。结果 我们的分析中总共包括了 460 个动态 CLABSI。在 379 (82.3%) 例中尝试了 CVC 抢救。潜在的诊断、CVC 类型、管腔数量和没有念珠菌血症与尝试挽救相关。在 287 起 (75.7%) 未遂案件中打捞成功。基础诊断、CVC 类型、管腔数量和无念珠菌血症与成功挽救相关。在恶性肿瘤患者中，CLABSI 前 30 天内的中性粒细胞减少与试图抢救和成功抢救均显着相关。结论 在出现 CLABSI 的非卧床儿科患者中，CVC 抢救经常被尝试并且经常成功。