Diagnosis, prevention, and management of catheter related bloodstream infection during long term parenteral nutrition

CR-BSI is an important cause of morbidity and mortality in children receiving PN. An important proportion of cases arc iatrogenic and potentially preventable. Dedicated nutrition teams have been shown to reduce the incidence of CR-BSI, and units caring for children requiring long term PN should have standardised protocols for catheter care and management. The incidence of the condition should be regularly audited. The AOLC test combined with qualitative or automated paired peripheral vein/catheter cultures provides the most rapid and accurate diagnosis with the catheter in situ. Local first line "blind" antibiotic regimens should be established in combination with the microbiology department, and "through-catheter" treatment given. Advances in catheter design have proven effective in adult patients, but further studies to assess their role in the paediatric population are needed.