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Risks of treating infected neonatal lines
- Kiran Nistala, Richard Nicholl (6 September 2002)
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Catheter related blood stream infection in children receiving long term parenteral nutrition
- John W Puntis, Donald Hodge (6 September 2002)
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Kiran Nistala, Doctor Northwick Park Hospital, Richard Nicholl
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kiran{at}nistala.freeserve.co.uk Kiran Nistala, et al.
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Dear Editor Hodge and Puntis[1] suggest that "up to 80 % of coagulase negative staphylococcus infection... in young children can be eradicated with antibiotics". The study referenced, Raad et al.[2] was carried out in adults (mean age 43 yr) with underlying malignancy, most of whom had non-tunnelled subclavian lines. It may not be appropriate to apply Raad et al.’s results to children with long term parental nutrition, in view of the differences in age, illness, and catheter type. The authors endorse the treatment of infected central venous catheters in situ without an adequate appraisal of the risks. In the neonatal population retention of catheters has a lower success rate than suggested them with only 50 % of catheters being successfully treated.[3] Importantly, treating catheters rather than immediate removal significantly prolonged the bacteremia. The risk of bacterial end organ damage increases with each day that there are positive cultures.[4] R Nicholl
K Nistala References (1) D Hodge, JWL Puntis. Diagnosis, prevention and the management of catheter related bloodstream infection during long term parental nutrition. Arch Dis Child Fetal Neonatal Ed 2002;87:F21-F24. (2) Radd I, Davis S, Khan A, Tarrand J, Elting L, Bodey G. Impact of central venous catheter removal on the recurrence of catheter- related coagulase negative staphylococcal bacteremia. Infect Control Hosp Epidemiol 1992;13:215-21. (3) Karlowicz MG, Furigay PJ, Croitoru DP, Buescher ES. Central venous catheter removal versus in situ treatment in neonates with coagulase-negative staphylococcal bacteremia. Pediatr Infect Dis J 2002 Jan;21(1):22-7. (4) Benjamin DK Jr, Miller W, Garges H, Benjamin DK, McKinney RE Jr, Cotton M, Fisher RG, Alexander KA. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 2001 Jun;107(6):1272-6. |
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John W Puntis, Consultant Paediatric Gastroenterologist Leeds General Infirmary, Donald Hodge
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john.puntis{at}leedsth.nhs.uk John W Puntis, et al.
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Dear Editor We thank Drs Nistala and Nichol for their comments on our leading article concerned with management of catheter related blood stream infection in chldren receiving long term parenteral nutrition. The points they make with regard to neonates may well have some validity, but our paper relates to children on parenteral nutrition for many months, and sometimes years. The balance of risk and benefits when treating infected central venous catheters in situ is clearly quite different in this group in whom loss of venous access may well jeopardise survival. We emphasise the point that experience in adults has established that eradication of catheter sepsis is possible, because it has been common clinical practice in some centres to remove catheters on suspicion of sepsis rather than even attempt treatment with antibiotics. This has relevance to children on long term parenteral nutrition, notwithstanding that findings of studies in one population should not be mechanically applied to another. Our own experience with treating catheter related infection in children well beyond the newborn period was cited.[1,2] We suspect that Nistal and Nichol have been mislead by an arguably perverse editorial decision to place our review in the Fetal and Neonatal Edition of Archives. We can only agree that it is not appropriate to apply our observations based on a review of the adult and paediatric literature to short term PN via percutaneous catheters in the newborn. Perhaps some intimation of our area of focus might have been gained from the fact that we did not include a single paper on the subject of their letter (i.e. central lines in the neonate) among the 55 references cited in our review? References (1) Page S, Abel G, Stringer MD, et al. Management of septicaemic infants during long term parenteral nutrition. Int J Cln Pract 2000;54:147 -50 (2) Hoy CM, Kite P, Abel G, et al. The role of quantitative blood culture surveillance in the diagnosis and management of central venous catheter sepsis. Clin Nutr 2000;19(suppl 1):38. |
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