Central Venous Catheter-Associated Bloodstream Infections in Pediatric Oncology Home Care

2002 ◽  
Vol 23 (2) ◽  
pp. 99-101 ◽  
Author(s):  
Samir S. Shah ◽  
Mary Lou Manning ◽  
Elizabeth Leahy ◽  
Mark Magnusson ◽  
Susan R. Rheingold ◽  
...  
Keyword(s):  
Home Care ◽  
Pediatric Oncology ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Home Care Services ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Oncology Patients ◽  
Care Services ◽  
Gram Negative Organisms

AbstractFifty-two pediatric oncology patients with central venous catheters (CVCs) who received home care services were studied. Gram-negative organisms were responsible for a greater proportion of CVC-associated bloodstream infections in pediatric oncology patients receiving home care than in hospitalized pediatric oncology patients.

scholarly journals 580. Association Between Central Venous Catheter Repair and Bloodstream Infections in a Pediatric Oncology Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S274-S274
Author(s):  
Ruba Barbar ◽  
Hana Hakim ◽  
Patricia Flynn ◽  
Aditya H Gaur ◽  
Darenda Wright ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Pediatric Population ◽  
Healthcare Delivery ◽  
Significant Risk ◽  
Bloodstream Infections ◽  
Categorical Variables ◽  
Central Venous ◽  
Oncology Patients ◽  
Increased Risk ◽  
Oncology Center

Abstract Background Central venous catheters (CVCs) are important for healthcare delivery in pediatric oncology patients. It is common to repair CVC breakage to prevent replacement. Existing evidence regarding the association between CVC repair and bloodstream infections (BSI) is limited in the general pediatric population and lacking in pediatric oncology patients. We aim at evaluating whether repairing broken CVCs is associated with an increased risk for subsequent BSI in a pediatric oncology center. Methods This is a retrospective case-crossover study of pediatric oncology patients with broken CVCs that underwent repair between July 2015 and June 2017. The incidence and characteristics of BSI in the 30-day pre-repair period were compared with those in the 30-day post-repair period. Wilcoxon-Mann–Whitney and Fisher’s Exact tests were used for comparison of continuous and categorical variables, respectively. Univariate logistic regression was used to identify potential risk factors for BSI post CVC repair. Multiple breakages of the same CVC, and BSIs in overlapping observation periods of consecutive breakages are assumed independent. Results Sixty-four patients had 99 episodes of CVC breakage/repair in 68 CVCs. Median age (range) at repair was 2.5 (0.15–17.6) years. 48% of CVC breakages occurred in patients with solid tumors, 24% in HSCT recipients, and 19% in patients with leukemia. Only 25% of patients had neutropenia at repair and 14% had CVC occlusion 72 hours prior to breakage. All CVCs were made of silicone and 88% were double lumen external tunneled. First CVC breakage occurred at a median (range) of 130 (2–718) days since insertion, and CVCs were removed at a median (range) of 72.5 (3–753) days from the last repair. End of treatment was the most common cause (43%) for removal. The post-repair incidence of BSI was 4.5 per 1000 line-days compared with a pre-repair incidence of 4.3 (RR= 0.95, 95% CI 0.44, 2.18). There is no statistical difference between the characteristics of the pre-repair and post-repair BSI (Table 1). Figure 1 shows the organisms causing BSI before and after CVC repair. None of the evaluated variables was identified as a significant risk factor for BSI 30 days after CVC repair (Table 2). Conclusion Repair of CVC in pediatric oncology patients was not associated with increased risk of BSI. Disclosures All authors: No reported disclosures.

High success rate in salvage of catheter-related bloodstream infections due to Staphylococcus aureus, on behalf of project group of Italian society of nephrology

2019 ◽  
Vol 21 (3) ◽  
pp. 336-341
Author(s):  
Salvatore Mandolfo ◽  
Adriano Anesi ◽  
Milena Maggio ◽  
Vanina Rognoni ◽  
Franco Galli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Prognostic Index ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Removal ◽  
Renal Unit ◽  
Chronic Haemodialysis ◽  
Central Venous

Background: Catheter-related bloodstream infections caused by Staphylococcus aureus represent one of the most fearful infections in chronic haemodialysis patients with tunnelled central venous catheters. Current guidelines suggest prompt catheter removal in patients with positive blood cultures for S. aureus. This manoeuvre requires inserting a new catheter into the same vein or another one and is not without its risks. Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days. Results: We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by S. aureus, including 19 by methicillin-resistant S. aureus (79% saved) and 21 by methicillin-sensitive S. aureus (90% saved), of which 34 (85%) were treated successfully. Eight recurrences occurred and six (75%) were successfully treated. A greater than 12 h time to blood culture positivity for S. aureus was a good prognostic index for successful therapy and tunnelled central venous catheter rescue. Conclusion: Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by S. aureus and to avoid removing the tunnelled central venous catheter in many more cases than what has been reported in the literature. On the third day, it is mandatory to decide whether to replace the tunnelled central venous catheter or to carry on with antibiotic therapy. Apyrexia and amelioration of laboratory parameters suggest continuing systemic and antibiotic lock therapy for no less than 4 weeks, otherwise, tunnelled central venous catheter removal is recommended.

P10 Evaluation of existing line-locking practice in central venous catheters of paediatric patients on home parenteral nutrition

2018 ◽  
Vol 103 (2) ◽  
pp. e1.14-e1
Author(s):  
Tustin Amy ◽  
Hartley Karen ◽  
Derry David ◽  
Thomas Julian
Keyword(s):  
Parenteral Nutrition ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Venous Catheters ◽  
Home Parenteral Nutrition ◽  
List Type ◽  
Central Venous ◽  
Paediatric Patients

AimTo review current line-locking practice of central venous catheters (CVCs) to reduce catheter related blood stream infections (CRBSIs) and preserve line integrity in paediatric patients on home parenteral nutrition (HPN), with the secondary aim of producing a concise, evidence-based guideline for use in this cohort and inpatient PN patients as well.MethodAll 19 paediatric HPN patients were reviewed retrospectively over 6 months (January–June 2017). Data was collected from clinic letters, HPN prescriptions and blood cultures. Information gathered per patient:Line lock(s)Infective episode(s)CVC replacement(s)Establishment of current practice: All patients use TaurolockTM first-line. If CVC is stiff or stops bleeding back switch to TauroLockTM-Hep100. Should problems persist introduce alcohol 70% on alternate days or alone if recurrent infections occur on TaurolockTM. Blocked CVCs are instilled with urokinase or alteplase and CVC replaced if unsuccessful.Results18/19 patients were prescribed line locks as per above practice. One patient is prescribed heparin 10units/ml – due to a documented TauroLockTM allergy – and remained infection- free throughout. 7 infections occurred overall in 6 patients with 13 patients infection-free. 2.2 infections/1000 catheter days occurred in patients on TauroLockTM with 2 patients requiring CVC changes due to infection and broken CVC respectively.1 infection/1000 catheter days occurred on TauroLockTM- Hep100 with 2 CVC changes required due to occlusion. 11 infections/1000 catheter days occurred in 1 patient on daily alcohol 70%, although result validity is uncertain due to potential contamination of blood culture specimen from skin organisms during sampling. No infections occurred in 248 catheter days in patients alternating TauroLockTM-Hep100 and alcohol 70% with one line change required as CVC moved position.ConclusionCRBSIs pose a serious problem in paediatric HPN patients.1,2 Taurolidine has proven efficacy at preventing CRBSIs and proven superiority to heparin.3 The effectiveness of alcohol at reducing CRBSI rates and preventing CVC replacement has been proven when compared to heparin4 however, due to adverse effects (thrombosis and CVC degradation)4 use is limited to ensure benefits outweigh risks. These studies, although limited, and results in our patient cohort support the continued use of these line locks as per existing practice. Future work includes need to formalise written guideline and discuss clear pathway if patients have multiple CRBSIs on their existing line lock as presently information is unclear.ReferencesKoletzko B, Agostoni C, Ball P, et al. ESPEN/ESPGHAN guidelines on paediatric parenteral nutrition. Journal of Paediatric Gastroenterology and Nutrition2005;41:S76–S84.Candusso M, Faraguna D, Sperli D, et al. Outcome and quality of life in paediatric home parenteral nutrition. Current Opinion in Clinical Nutrition and Metabolic Care2005;5:309–14.Chu HP, Brind J, Tomar R, et al. Significant reduction in central venous catheter-related bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr2012;55:403–7.Oliveira C, Nasr A, Brindle M, et al. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: A meta-analysis. Paediatrics2012;129:318–329.

Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

2009 ◽  
Vol 28 (3) ◽  
pp. 151-155 ◽  
Author(s):  
Sabra Curry ◽  
Michele Honeycutt ◽  
Gail Goins ◽  
Craig Gilliam
Keyword(s):  
High Risk ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Skin Antisepsis ◽  
Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

Bacteremia in nonneutropenic pediatric oncology patients with central venous catheters in the ED

2017 ◽  
Vol 35 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Risha L. Moskalewicz ◽  
Leidy L. Isenalumhe ◽  
Cindy Luu ◽  
Choo Phei Wee ◽  
Alan L. Nager
Keyword(s):  
Pediatric Oncology ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Oncology Patients
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