Table 2 Treatment strategies for catheter-related bloodstream infections in children
Intervention | Method | Potential mechanism | Risk of harm | Population | Results | Comments | Level of evidencea |
|---|---|---|---|---|---|---|---|
Physical removal | Eliminating suspected focus of infection | Insertion of new line may be required for adequate treatment | Neonatal ICU Children with short bowel syndrome receiving PEN [94] Children with a CVC diagnosed with candidemia [95] | Conflicting interpretations of results | Individual, clinical evaluation recommended | 2b | |
Systemic antibiotics | Conventional treatment of bloodstream infection | Killing susceptible free-floating planktonic micro-organisms | Depends on safety profile of each drug- | - | - | No pediatric studies of catheter colonization and biofilm disruption | - |
Luminal instillation of highly concentrated antibiotic solutions for 8 to 12 hours daily for up to 14 days | Penetrating biofilm and eradicating susceptible embedded micro-organisms | Antibiotic resistance | Pediatric patients with confirmed CRBSI [107] Adults and children receiving PEN at home with confirmed bacteremia [108] Adults and children with chronic renal failure undergoing hemodialysis with confirmed CRBSI [109] Children receiving PEN with confirmed staphylococcal CRBSI [110] | Immediate success rates between 83 and 100% | Five small studies Questionable choice of outcome Treatment occupies the line for many hours | 2b | |
Ethanol: luminal instillation for 12 to 24 hours | Disrupting biofilm through protein denaturation and baring micro-organisms to systemic antibiotics | Systemic side effects | Children in pediatric ICU with confirmed CLABSI [114] Pediatric oncology patients with a CVC and bacteremia [115] Pediatric patients with a CVC and persistent bacteremia (>48 hours) [116] | Ethanol: immediate success rates between 67 and 88% | Ethanol: in large trials, benefit uncertain as a preventive measure | 2b | |
|  | Hydrochloric acid: luminal instillation for 3 × 10 minutes within 1 day |  | Systemic side effects Possible catheter damage | (>48 hours) [116] Pediatric oncology patients with | Hydrochloric acid: immediate success rate = 67% (85% CI = 52.9 to 82.3%) [112] Significantly more CVCs in situ after >100 days [111] | Hydrochloric acid: very few, small studies | 2b |