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Long-term outpatient central venous catheters for bone infections cause complications in about 40 percent of children

A new study questions the benefit of treating children who have bone infections with prolonged antibiotic treatment through central venous catheters at home. Bone infections account for 1 percent of all pediatric hospitalizations in the United States, typically arising after a bacterial infection in the bone, with a diagnosis of acute hematogenous osteomyelitis (AHO). About 50 percent of cases occur among children younger than 5 years, possibly because of the rich vascularization of rapidly growing bones. A common approach to treating AHO consists of several days of peripheral intravenous (IV) antibiotic administration in the hospital, followed by placement of a central venous catheter (CVC) in a vein that leads directly to the heart, for 4 to 6 weeks of IV antibiotic therapy at home.

However, the new study found that 41 percent of children who received more than 2 weeks of CVC therapy at home had one or more CVC-associated complications. Many of these complications were serious enough to warrant a visit to the emergency department or readmission to the hospital. Most CVC-associated complications occurred after 2 weeks of catheter placement. A total of 23 percent of children had a CVC malfunction or displacement, 11 percent had a catheter-associated bloodstream infection, 11 percent had fever with negative blood culture results, and 5 percent had a local skin infection at the site of catheter insertion.

Complications were more likely among younger children and those living in Zip codes with the lowest household incomes. Parents of these children may benefit from more teaching and nursing supervision, note researchers at the University of Pennsylvania Center for Education and Research on Therapeutics, who were supported in part by the Agency for Healthcare Research and Quality (HS10399). They retrospectively studied 80 children diagnosed with AHO (median age of 5 years), who were admitted to one children's hospital between January 1, 2000 and December 31, 2003. Overall, 94 percent of children received over 2 weeks of IV antibiotic therapy via a CVC. Six percent received less than 2 weeks of IV antibiotic therapy before conversion to oral therapy for a median of 25 days. Recent studies have shown the latter approach to be effective for AHO.

See "Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis," by Rebecca Ruebner, M.D., Ron Keren, M.D., M.P.H., Susan Coffin, M.D., M.P.H., and others, in the April 2006 Pediatrics 117(4), pp. 1210-1215.

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