Infecção da corrrente sanguínea associada a cateter em pacientes pediátricos em uso de nutrição parenteral

Abstract

Introduction: Central line-associated bloodstream infections (CLABSI) represent a major cause of morbidity and mortality in pediatric patients receiving parenteral nutrition (PN). Identifying risk factors, characterizing microbiological profiles, and evaluating instituted treatments are essential for optimizing prevention strategies and therapeutic management. Objectives: To describe the epidemiology of CLABSI, identify risk factors for its development, analyze the microbiological profile of isolated pathogens, and assess the treatments used, including the adequacy of antimicrobial therapy and its impact on clinical outcomes. Methods: A retrospective observational study was conducted in the Pediatric Inpatient Units of HC-UFMG, analyzing pediatric patients receiving PN who developed CLABSI between November 2015 and June 2021. Results and Discussion: The prevalence of CLABSI was 44.7%, with an incidence density of 22.1 per 1,000 catheter-days. Catheter dwell time, duration of parenteral nutrition, and the number of catheter replacements were significantly associated with the development of CLABSI. The most prevalent groups were Enterobacterales (27.4%), coagulase-negative Staphylococcus (26.5%), and Candida spp. (25.6%). Among Gram-negative bacilli, 38.6% were resistant, with even higher rates in the onco-hematologic subgroup (83.3%). The resistance observed in Acinetobacter spp. (50%) and Pseudomonas aeruginosa (75%) highlights the challenges in managing these infections and the need for individualized approaches. Overall mortality was 13.0%, and antimicrobial resistance was the only statistically significant factor associated with death among the variables analyzed (66.7% vs. 21.8%; p = 0.03). None of the empirical regimens used in fatal cases provided effective coverage for the isolated pathogens. Conclusion: These findings highlight that, despite the high complexity of pediatric patients receiving parenteral nutrition, CLABSIs are potentially preventable infections. Implementing multidimensional strategies, including prevention bundles, active surveillance, continuous education, adherence monitoring to protocols and performance feedback, may contribute to reducing CLABSI incidence and mortality, particularly in facilities caring for high-complexity pediatric patients.