Patients receiving home parenteral feeding are more vulnerable to central line-associated bloodstream infections (CLABSI). However, there are no published guidelines for the antibiotic treatment of suspected CLABSI in this group. Historical microbiology data may aid in the development of empiric antibiotic regimens for this population. The study’s goal was to describe antimicrobial resistance trends and establish the best empiric antibiotic treatment for HPN-dependent infants with community-acquired CLABSI. A single-center retrospective cohort study was conducted to assess the potential coverage of empiric antibiotic regimens in HPN children who developed a community-acquired CLABSI. There were 309 CLABSI events among 90 HPN-dependent children with a median age of 3.8 years between October 1, 2011 and September 30, 2017. The diagnosis of surgical small bowel syndrome was given to 59% of the patients. The organisms identified during these illnesses were composed of 60% Gram-positive bacteria, 34% Gram-negative bacteria, and 6% fungus. Methicillin resistance was found in 51% of all staphylococcal isolates. Sensitivities were 71 percent for piperacillin-tazobactam, 97 percent for cefepime, and 99 percent for meropenem among enteric Gram-negative pathogens. In 69 percent of instances, organisms were responsive to current institutional standard therapy with vancomycin and piperacillin-tazobactam, compared to 85 percent and 96 percent of cases with vancomycin and cefepime or vancomycin and meropenem, respectively.
Methicillin-resistant staphylococci and enteric Gram-negative organisms should be included in empiric antimicrobial treatment for suspected CLABSI in HPN-dependent children. Clinical outcomes based on evidence-based antibiotic regimens will need to be evaluated in future research.
