444 - Rates of Bacteremia in Non-Oncologic Patients without Intestinal Failure who Present with Fever in the Setting of a Central Venous Catheter in the Pediatric Emergency Department

Publication Number: 444.6288

Rachel Kortman, Phoenix Children's Hospital, Phoenix, AZ, United States; Emma Albrecht, Phoenix Children's Hospital, Phoenix, AZ, United States; Claudia Yeung, Phoenix Children's Hospital, Phoenix, AZ, United States; Quinney Fu, Phoenix Children's, Phoenix, AZ, United States; Romy Shane, Phoenix Childrens, Phoenix, AZ, United States; Hamy Temkit, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Central line associated blood stream infections are associated with significant increase in morbidity and mortality for pediatric patients who present with fever in the setting of a central line. Prior studies have explored the rate of bacteremia in patients with an oncologic diagnosis and intestinal failure (IF), but the outcomes, and therefore approach, are less defined for patients who do not fit in these two categories.1,2,4 This makes it difficult to determine the risks for this population, which results in variability in workup and disposition.

Objective: 1) To describe the rates of bacteremia in patients with a central venous catheter (CVC) without an oncologic diagnosis or IF who present to the emergency department (ED) with a fever; 2) To evaluate the workup and disposition of this population.

Design/Methods: A retrospective chart review of patients ages 0 to 18 years presenting to a pediatric tertiary ED with a fever and CVC was performed from January 2019 to December 2022. The data was summarized using frequencies and proportions for categorical variables while mean and standard deviation or median and interquartile range were used for continuous variables. The group comparisons were conducted using the chi-squared test for categorical variables and the Wilcoxon rank-sum or Kruskal-Wallis test for continuous variables. The significance level of alpha is 0.05.

Results: A total of 837 charts met inclusion criteria (Figure 1). The rate of bacteremia in patients without IF was 49% compared to 83% of patients with IF (p < 0.0001) (Figure 2). Of the patients without IF, 41.4% were discharged home while 58.6% were admitted. In comparison, 7.6% of patients with IF were discharged home and 92.4% were admitted (p < 0.001). Of the patients discharged home, there was no significant difference in the 72-hour ED return rate (p 0.6256). Patients without IF were more likely to receive ceftriaxone, whereas patients with IF were more likely to receive gentamicin and ampicillin-sulbactam (p < 0.0001). Both groups received intravenous fluids at similar rates of 93% and 96.4% respectively (p 0.0518) (Figure 3).

Conclusion(s): Patients without an oncologic diagnosis or IF have a high rate of bacteremia which is similar to published rates of bacteremia in patients with IF.3 The two groups received different empiric antibiotics and have different rates of hospitalization without a significant rate of ED return visits when discharged. Further research regarding this unique patient population would be beneficial to protocolize the management and disposition of these patients on presentation to the ED with a fever.

Inclusion Criteria


Rate of Bacteremia
Figure 2: This table demonstrates the rate of bacteremia in patients without the diagnosis of intestinal failure as compared to patients with the diagnosis of intestinal failure (p <0.0001, Chi-Square test).

ED Management and Disposition
Figure 3: This figure demonstrates that there is a statistically significant difference if disposition of patients with the diagnosis of intestinal failure and without intestinal failure (p <0.0001), but no significant difference in whether they received IVF or ED return rate in 72 hours. Additionally, it demonstrates a statistically significant difference in which empiric antibiotic they received (p <0.0001). P-values calculated using Chi-Square test.