Catheter-associated bloodstream infections in pediatric hematology-oncology patients: Factors associated with catheter removal and recurrence

Amos Adler*, Isaac Yaniv, Ester Solter, Enrique Freud, Zmira Samra, Jerry Stein, Salvador Fisher, Itzhak Levy

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

The aims of this study were to analyze the factors associated with antibiotic failure leading to tunneled central venous catheter (CVC) removal during catheter-associated bloodstream infections (CABSIs) and with recurrence and reinfection in children with cancer. All cases of CABSI in patients attending the Department of Pediatric Hematology-Oncology between November 2000 and November 2003 were reviewed. A total of 207 episodes of CABSI, including multiple episodes involving the same catheter, were identified in 146 of 410 tunneled CVCs (167 Hickman, 243 implantable ports). The most common organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in 96 (46%) episodes. Hypotension, persistent bacteremia, previous stem cell transplantation, multiple CABSIs in the same CVC, exit-site infection, inappropriate empiric antibiotic therapy, and Candida infection were all significantly associated with increased risk of catheter removal (P < 0.05, odds ratios 7.81, 1.14, 2.22, 1.93, 3.04, 2.04 and 24.53, respectively). There were 12 episodes of recurrent infection, all except 1 caused by CONS (odds ratio 20.5, P = 0.006). Inappropriate empiric therapy, especially in implantable ports, was the only mutable risk factor for antibiotic failure. Because CONS was the predominant isolate in these devices, adding glycopeptides to the empiric therapy for suspected implantable-port CABSI might decrease the removal rate. This issue should be explored in future controlled trials.

Original languageEnglish
Pages (from-to)23-28
Number of pages6
JournalJournal of Pediatric Hematology/Oncology
Volume28
Issue number1
DOIs
StatePublished - Jan 2006

Funding

FundersFunder number
National Science FoundationDMI-9502109, DMI-9628984, DMI-0070088
Manufacturing Institute
Ford Motor Company
Cooper Industries
Australian Federation of Graduate Women Inc.

    Keywords

    • Catheter removal
    • Catheter-associated bloodstream infection
    • Hickman
    • Implantable ports
    • Recurrence

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