Treatment outcomes in pediatric intestinal failure patients with ambulatory Candida central line-associated bloodstream infections with and without central venous line removal: A retrospective case series.

Abstract

Background: Lack of central venous line (CVL) sites is a common indication for intestinal transplantation in intestinal failure (IF) patients. For treatment of central line-associated bloodstream infections (CLABSIs), many pediatric gastroenterologists preserve CVL access, but line removal is typically recommended for Candida sp CLABSI due to high risk of systemic complications. However, no data exist on outcomes for IF patients treated for Candida sp CLABSI. This study aims to assess if CVL preservation increases the risk of complications or recurrence.

Materials and methods: A retrospective chart review was conducted for children <18 years of age with IF and Candida sp CLABSI between 2012 and 2023. Patients with blood cultures positive for Candida sp from the CVL were included. Each CLABSI event was analyzed for key variables.

Results: Twelve patients were included, with 18 events (median age 6.4 years). Candida species identified included C albicans (33.3%) and C parapsilosis (38.9%). Antifungal therapy exceeded 14 days in all events, and ethanol lock therapy (70% concentration) was used in 72%. CVL was removed in 44.4% of events. Five patients had multiple events, with Candida species identified in subsequent infections. No secondary site seeding or long-term sequelae occurred, and no patients died.

Conclusion: Our data suggest that CVL preservation in pediatric IF patients with Candida sp CLABSI is feasible without increased complications or mortality. Limitations include small sample size and retrospective design.