Prevalence and Predictors of Central Line Associated Bloodstream Infections in Pediatric Intestinal Failure: A Retrospective Study from a Tertiary Center in Saudi Arabia

Background Pediatric intestinal failure (IF) often requires long-term total parenteral nutrition (TPN) via central venous catheters, which predispose to central line-associated bloodstream infections (CLABSIs). Data from Saudi Arabia are limited, particularly for emergency department (ED) presentations. We aimed to describe the prevalence, microbiological profile, and predictors of CLABSI among pediatric IF patients on home TPN presenting with fever to the ED. Methods A retrospective cohort study was conducted at King Fahad Medical City, Saudi Arabia, including children aged 3 months-14 years with IF on long-term TPN who presented to the ED with fever (≥ 38°C) between January 2021 and June 2024. Demographics, vital signs, laboratory values, microbiology, management, and outcomes were analyzed. Logistic regression was used to identify predictors of CLABSI. Results A total of 182 patients were included; nearly half of them were aged 1–5 years, and 85.2% had tunneled central venous catheters. The overall CLABSI prevalence was 53.8%, corresponding to 1.24 per 1,000 catheter days. Common pathogens included Staphylococcus epidermidis (18.9%), Klebsiella spp. (14.7%), polymicrobial growth (11.6%), and methicillin-resistant Staphylococcus aureus (10.5%). Independent predictors of CLABSI included abnormal blood pressure (OR 0.36; 95% CI 0.21–0.63; p < 0.005), while inflammatory markers were not predictive. Respiratory viral panel positivity was associated with a lower CLABSI risk (p = 0.035). Empiric antibiotics were initiated in 91% of patients; vancomycin plus piperacillin–tazobactam was most commonly used, though not always guideline-concordant. Line removal was infrequent (8.8%), despite recurrent infections in some cases. Outcomes were favorable, with 97.8% discharged without complications. Conclusion More than half of pediatric IF patients presenting with fever to the ED had CLABSI, with Staphylococcus epidermidis and Klebsiella spp. predominating. Arrival vital signs, clinical parameters, and traditional inflammatory markers were not useful predictors of CLABSI. Optimized empiric antibiotic pathways and stronger antimicrobial stewardship programs are needed to improve care for this high-risk population.