295 Conclusions, general discussion and future perspectives Chapter 14 one third of the children treated for intestinal atresia or gastroschisis. We identified treatment by enterostomy and non-tunneled catheters to be independent risk factors for CLABSI development, whilst patient’s sex, catheter placement directly into central vein, preterm birth, trisomy 21, experiencing a major postoperative complication (ClavienDindo grade ≥III) and birthweight weren’t. Additionally, catheter related thrombosis occurred in one in fourteen. Whilst a correlation was found between occurrence and the placement of non-tunneled catheters, no correlation was found between different locations of insertion. In this study we noted a large difference in CLABSI occurrence compared to previous studies-based cohorts created by using coding systems such as CD-10. [4] Compared to our reported incidence of 35% as well as other incidences (13-18%) from previous literature, the incidences of 2-4% reported in coding system-based studies seems too low to be a correct representation.[5] We fully support the use of national databases; they are increasingly more available and they will undoubtfully lead to discoveries based on correlations within large datasets which could otherwise never be discovered by smaller hospital specific datasets. However, care has to be taken in the development of these databases to decrease the influence of underreporting and coding error as much as possible. Still, we also have to be critical of our own incidence, which is comparatively high. This might be a reflection of the very broad definition used in our hospital, compared to the international guidelines. Because of this we might have over-diagnosed patients, resulting in catheter removal whilst watchful waiting might have resulted in clinical improvement. Our study raised awareness in our hospital to better adhere to the existing guidelines. To do so, we hope to set up a multidisciplinary team dedicated to central line management in the near future. This hopefully will decrease the amount of (overly cautious) removal of catheters from now on. It is our goal to re-evaluate our cohorts in a couple of years’ time to see if this is the case. The high incidence of CLABSI furthermore led to action by means of prevention. Because of this, we started with taurolidine, an antiseptic line-lock infusion, which effects we also aim to re-evaluate in the nearby future. Moreover, based on our results, we are now more likely to prefer a tunneled catheter over a non-tunneled one if patients are treated with an enterostomy or if a longer duration of TPV treatment is deemed likely. Though a non-tunneled catheter might still be preferred in patients with a short (under 30 days) dwell time because of practical reasons (e.g, sparing the central veins and comparatively minor surgery).
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