Pathogen-specific clinical and inflammatory phenotypes in pediatric catheter-related infections

Abstract Early empirical management of pediatric catheter-related infections (CRI) is complicated by delayed microbiological confirmation and heterogeneous local pathogen epidemiology. Pathogen-specific clinical and inflammatory profiling may facilitate contextual risk assessment at the time of clinical suspicion. In this retrospective single-center cohort study, 291 CRI episodes contributed by 177 pediatric patients between March 1, 2020, and February 29, 2024, were analyzed. Clinical variables at catheter insertion and inflammatory biomarkers at infection onset were evaluated. CRI episodes were classified according to the first clinically significant isolate. Multivariable logistic regression models explored predictors of (i) Gram-negative versus Gram-positive CRI and (ii) fungal versus bacterial CRI. During 24,846 catheter days of follow-up, the incidence density (rate per 1000 catheter days) was 11.7 per 1000 catheter days (95% CI 10.4–13.1). A causative pathogen was identified in 94.2% of episodes: 51.1% Gram-positive, 40.5% Gram-negative, and 8.4% fungal. Gram-negative infections were associated with higher CRP, PCT, and NLR levels. PCT demonstrated the highest discriminatory capacity for Gram-negative CRI (AUC 0.663, 95% CI 0.593–0.734). Lymphocyte count showed moderate discrimination for fungal CRI (AUC 0.711). Conclusions : Pediatric CRI exhibit pathogen-associated inflammatory and device-related patterns; however, discriminatory performance of individual biomarkers remains modest. These findings may support contextual risk assessment at first suspicion but do not justify modification of guideline-based empirical therapy without prospective validation. What is Known: • Pediatric catheter-related infections (CRI) are prevalent in tertiary care settings, particularly among children with hematologic or oncologic disorders. • The early clinical presentation of the condition is often non-specific, and microbiological confirmation is frequently delayed, necessitating empirical therapy. • Gram-positive organisms predominate; however, Gram-negative and fungal pathogens are increasingly reported. • Inflammatory biomarkers, including CRP and procalcitonin, are frequently utilized in clinical practice, though their capacity to differentiate among different pathogen classes remains equivocal. What is New: • In a cohort of 177 children, contributing 291 CRI episodes, the incidence density was 11.7 per 1000 catheter days. • Distinct pathogen-associated phenotypes were identified: Gram-negative CRI exhibited a more pronounced inflammatory profile, while fungal CRI were more frequently associated with temporary and multi-lumen devices. • Despite the presence of statistically significant associations, the capacity for discrimination between pathogen classes based on biomarkers was modest (AUC ≤ 0.66 for Gram-negative differentiation), underscoring the limitations of relying on a solitary biomarker. • These findings support the implementation of structured, multivariable contextual assessment as a preferred approach over decision-making based exclusively on biomarkers at the initial stage of clinical suspicion.