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Children with intestinal failure (IF) requiring parenteral nutrition (PN) are at risk of catheter-related bloodstream infection (CRBSI), a life-threatening complication. 1 With increasing use of home PN (HPN) among paediatric patients,2 ongoing surveillance of CRBSI rates is essential. Annual audits on CRBSI outcome measurements guide best practice in IF and HPN centres,3 with a target CRBSI rate of less than 1 per 1000 catheter days.4 At this tertiary centre, possible CRBSI is defined by a temperature ≥ 38.5°C, or two measurements ≥ 38°C within one hour. Suspected cases would be evaluated for bacteraemia by obtaining blood culture and started on antimicrobial therapy infused through the central venous catheter (CVC) for fourteen days to achieve line salvage. CVC removal is reserved for fungal infections or persistently positive bacteraemia on days five and ten of infection.5 This retrospective cohort analysis evaluates the incidence and outcomes of CRBSI in children receiving long-term HPN for IF in a single large tertiary centre.A retrospective cohort analysis was conducted at a single large tertiary centre to evaluate rates of CRBSI for children with type 3 intestinal failure requiring long-term HPN. Data on patient demographics, underlying diagnosis, episodes of positive bacteraemia, and use of taurolidine-based antimicrobial locks were extracted from electronic health records (Cerner Millennium) for the years 2023-2024. Episodes involving viral infections or negative blood culture were excluded, even if antimicrobial therapy was initiated for suspected CRBSI. Statistical analysis was performed to compare annual CRBSI rates per 1000 catheter days and identify contributing factors.A total of 36 and 37 children received HPN in 2023 and 2024, respectively, with ages ranging from 6 months to 18 years. Indications for HPN were short bowel syndrome (65%), congenital enteropathy (19%), and gastrointestinal motility disorders (16%). In 2023, four children experienced eight episodes of CRBSI, corresponding to a CRBSI rate of 0.64 per 1000 catheter days – a 55% reduction from the previous audit. Half of these infections were caused by Gram-positive bacteria, 40% Gram-negative and 10% fungi. In 2024, two children had four CRBSI episodes, with an overall CRBSI rate of 0.31 per 1000 catheter days, reflecting a further 50% reduction in CRBSI rates. CVC salvage was achieved in 75% of CRBSI episodes. All patients made a full recovery from each CRBSI episode. Taurolidine-based antimicrobial lock use for CRBSI prophylaxis increased from 91% in 2023 to 100% in 2024.The national recommendation of CRBSI rate of less than 1 is achievable in children reliant on HPN. This data highlights the positive impact of a dedicated nutrition team, taurolidine-based antimicrobial lock, and adherence to clear guidelines to minimise this serious complication.References Pierret ACS, Wilkinson JT, Mann JP. Clinical outcomes in pediatric intestinal failure: a meta-analysis and meta-regression. Am J Clin Nutr. 2019 Aug 1;110(2):430–6.Wiskin AE, Thomas J, Batra A. Prevalence of home parenteral nutrition in children. Clin Nutr ESPEN. 2021 Apr;42:138–41.Bond A, Chadwick P, Lal S. Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition. Frontline Gastroenterol. 2020 Jan 1;11(1):48–54.Lal S, Chadwick P. British intestinal failure alliance (IFA) recommendation management of catheter related blood stream infections (CRBSIs). 2024 Jun.Patel M, Kadir A, Naik S. Standard Operating Procedure for line sepsis in Paediatric patients on long term parenteral Nutrition V1.1. London; 2024 Oct.