A retrospective study was conducted, including 61 patients with long-term intravascular devices (IVDs) admitted to the Childrens Hospital Los Angeles with diverse underlying diseases, different types of catheters, and culture-proven catheter-related bloodstream infections (BSIs). Within these patients, 125 catheter-related BSIs occurred, and the incidence of monomicrobial and polymicrobial BSIs was evaluated. Risk factors for polymicrobial BSIs were determined. Forty-two BSIs contained more than one pathogen. These polymicrobial BSIs were observed more often in younger patients (<4.1 years versus ≥4.1 years) and less in patients using venous implanted ports. No other associations were found between the occurrences of polymicrobial BSIs and underlying diseases, other types of catheters, host defense status, parenteral nutrition, recurrences, or catheter removal. Patients with long-term IVDs at a younger age have a higher risk of developing a polymicrobial BSI. Future prospective studies should address the issue of polymicrobial infection in IVDs in more detail. 1. Introduction Intravascular devices (IVDs) are a crucial tool in the treatment of pediatric patients with diverse underlying diseases. They provide a reliable access site for frequent transfusions of blood products, prolonged intravenous medications, chemotherapy, apheresis, parenteral nutrition, and blood sampling. However, catheter-related bloodstream infections (BSIs) have emerged as the most important cause of infections in children with intravascular devices (IVDs) [1]. More than 80% of primary bacteriaemia are considered to be catheter associated in the adult population [2]. The incidence of individual monomicrobial pathogens in BSIs have been studied identifying different risk factors, such as age, underlying disease, type of catheter, and immune status [3–6]. However, epidemiological data about the incidence and risk factors of catheter-related BSIs caused by polymicrobial infections are scarce [7]. Two reports in the 1980s and one study most recently describe polymicrobial bacteriaemia in children [8–10], identifying predisposing factors as underlying disease, types of IVD, and immune status. Age of the patients as a risk factor was not included. Recently, catheter-related BSIs were investigated in pediatric patients in ambulatory care, showing that younger children were at a greater risk of obtaining a polymicrobial infection than older children [11]. Since studies in adults have shown that polymicrobial infections are related to higher risks of mortality and morbidity, this
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