Abstract
Central venous catheters (CVCs) are indispensable in modern pediatric medicine. CVCs provide secure vascular access, but are associated with a risk of severe complications, in particular bloodstream infection. We provide a review of the recent literature about the diagnostic and therapeutic challenges of catheter-related bloodstream infection (CRBSI) in children and its prevention. Variations in blood sampling and limitations in blood culturing interfere with accurate and timely diagnosis of CRBSI. Although novel molecular testing methods appear promising in overcoming some of the present diagnostic limitations of conventional blood sampling in children, they still need to solidly prove their accuracy and reliability in clinical practice. Standardized practices of catheter insertion and care remain the cornerstone of CRBSI prevention although their implementation in daily practice may be difficult. Technology such as CVC impregnation or catheter locking with antimicrobial substances has been shown less effective than anticipated. Despite encouraging results in CRBSI prevention among adults, the goal of zero infection in children is still not in range. More high-quality research is needed in the field of prevention, accurate and reliable diagnostic measures and effective treatment of CRBSI in children.
Highlights
Central venous catheters (CVCs) are common and indispensable in modern pediatric medicine with an increasing number of patients requiring long-term vascular
Implantable port systems have the most favorable risk, while infection rates are higher in tunneled catheters and nontunneled CVCs [5]
Multimodal prevention strategies Avoiding contamination that would lead to subsequent CVC colonization is supposed to be the key element in decreasing the risk of central line-associated bloodstream infection (CLABSI) [11]
Summary
PubMed with the search terms ‘central venous catheter’ and ‘infection’ with the limitation of age (children up to 18 years). Articles published after 1999 and written in English were included. The title and abstract search focused on clinical studies, and only publications in line with all inclusion criteria were eligible for full-text review. Reference lists of reviews and clinical studies were used to retrieve additional literature from previous years. 435 studies were retrieved for title and abstract sift in PubMed, and a total of 127 studies fulfilled the inclusion criteria for full-text review from which 95 studies were chosen for detailed qualitative assessment
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