scholarly journals Rhizobium radiobacter bacteremia in a two-year-old patient with an acute lymphoblastic leukemia: a case report

2020 ◽  
Vol 12 (3) ◽  
pp. 1-8
Author(s):  
Biljana Kakaraskoska Boceska ◽  
Dugagjin Osmani ◽  
Branka Petrovska Basovska ◽  
Verica Kakaraskoska Petreska ◽  
Kata Martinova ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Venous Catheter ◽  
Marrow Transplant ◽  
Transplant Recipients ◽  
Central Venous ◽  
Rhizobium Radiobacter ◽  
Gram Negative ◽  
Plastic Materials ◽  
Aminoglycoside Therapy ◽  
Immunodeficiency Virus

Rhizobium radiobacter is a Gram-negative rod-shaped bacterium usually associated with diseases in plants. Infections due to R. radiobacter in humans are strongly related to the presence of foreign plastic materials, immunocompromised and chronically debilitated hosts with underlying conditions such as malignancies, human immunodeficiency virus as well as bone marrow transplant recipients. The aim of this paper was to present a rare blood infection with Rhizobium radiobacter in North Macedonia in a pediatric patient with underlying conditions. The treatment was successful with appropriate cephalosporin and aminoglycoside therapy without removing the central venous catheter

scholarly journals Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Johny Fares ◽  
Melissa Khalil ◽  
Anne-Marie Chaftari ◽  
Ray Hachem ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Cancer Patients ◽  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Mucosal Barrier ◽  
Central Venous ◽  
Gram Negative ◽  
Central Venous Catheter Removal ◽  
Mucosal Barrier Injury

Abstract Objective Gram-negative organisms have become a major etiology of bloodstream infections. We evaluated the effect of central venous catheter management on cancer patients with gram-negative bloodstream infections. Method We retrospectively identified patients older than 14 years with central venous catheters who were diagnosed with gram-negative bloodstream infections to determine the effect of catheter management on outcome. Patients were divided into 3 groups: Group 1 included patients with central line-associated bloodstream infections (CLABSI) without mucosal barrier injury and those whose infection met the criteria for catheter-related bloodstream infection; group 2 included patients with CLABSI with mucosal barrier injury who did not meet the criteria for catheter-related bloodstream infection; and group 3 included patients with non-CLABSI. Results The study included 300 patients, with 100 patients in each group. Only in group 1 was central venous catheter removal within 2 days of bloodstream infection significantly associated with a higher rate of microbiologic resolution at 4 days compared to delayed central venous catheter removal (3–5 days) or retention (98% vs 82%, P = .006) and a lower overall mortality rate at 3-month follow-up (3% vs 19%, P = .01). Both associations persisted in multivariate analyses (P = .018 and P = .016, respectively). Conclusions Central venous catheter removal within 2 days of the onset of gram-negative bloodstream infections significantly improved the infectious outcome and overall mortality of adult cancer patients with catheter-related bloodstream infections and CLABSI without mucosal barrier injury.

Prominent Prevalence of Coagulase-Negative Staphylococcus Bloodstream Infections in Neutropenic Hematology/Oncology Children with Central Venous Catheter

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4664-4664
Author(s):  
Young-Ho Lee ◽  
Yeon Jung Lim ◽  
Soon-young Song ◽  
Ji-hye Kim ◽  
Sung-hee Oh ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Retrospective Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative Bacteria ◽  
Central Venous ◽  
Gram Negative ◽  
Susceptibility Tests ◽  
Febrile Episodes

Abstract A retrospective analysis was performed on febrile neutropenic episodes in children with hematologic and oncologic diseases from 2005 to 2008. We reviewed total 255 febrile episodes occurred during the 3-year period in a total of 114 patients. Twenty-eight episodes of bacteremia occurred during neutropenic period in a total of 16 patients. All these patients had central venous catheter. There were 18 febrile episodes of Grampositive bacteria (64.3%), 9 episodes of Gram-negative bacteria (32.1%), and 1 episode of Candida (3.6%). The isolated organisms were as follows: Coagulase-negative Staphylococcus (CNS, N=17, 60.7%), Staphylococcus aureus (N=1, 3.6%), Enterobacter spp. (N=2, 7.1%), Pseudomonas spp. (N=2, 7.1%), Klebsiella (N=2, 7.1%), E. coli (N=2, 7.1%), Acinetobacter (N=1, 3.6%), Candida. (N=1, 3.6%). The bloodstream infection with CNS were more prevalent in children with Chemo-port (12 episodes in 6 from 34 patients, 17.6%) than in children with Hickman catheter (5 episodes in 5 from 22 patents, 22.7%), even though statistically not significant. In antibiotic susceptibility tests, all gram positive bacteria were resistant to penicillin and oxacillin, and sensitive to vancomycin and teicoplanin. In the case of Gram-negative bacteria, resistant rates to amikacin, gentamicin, imipenem, and piperacillin/tazobactam were 4.8%, 38.1%, 14.3%, and 42.9%, respectively. Based on this retrospective analysis, which reflects predominance of CNS bacteremia in febrile neutropenic patients, more emphasis needs to be laid on the empirical antibiotic regimen including vancomycin or teicoplanin as well as the strict skin preparations during procedures in children with central venous catheter.

Thromboelastography to Detect Hypercoagulability in Patients with Newly Diagnosed Acute Lymphoblastic Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1118-1118 ◽  
Author(s):  
Richard Har Ko ◽  
Richard Sposto ◽  
Fariba Goodarzian ◽  
Roxana Carmona ◽  
Siobhan Vasquez ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Central Venous Catheter ◽  
Prospective Study ◽  
Thrombin Generation ◽  
Lymphoblastic Leukemia ◽  
Venous Catheter ◽  
Newly Diagnosed ◽  
Older Children ◽  
Central Venous ◽  
Patient Demographics

Abstract Background: Patients with newly diagnosed acute lymphoblastic leukemia (ALL) are known to be hypercoagulable due to their disease and from side effects of chemotherapy. Studies have shown rates of venous thromboembolism (VTE) between 5-70% in patients with ALL (depending on various definitions and modalities of investigation) (Caruso et al, 2006, Mitchell et al, 2003). Established methods to monitor hypercoagulability or predict VTE do not exist. We have previously described methods using thromboelastography (TEG) to detect hypercoagulability (Ko et al., 2013). We believe that a global assay of hemostasis such as TEG holds promise to monitor hypercoagulability in patients with newly diagnosed ALL. Methods: This was a prospective study of newly diagnosed ALL patients between 1-21 years in whom a central venous catheter (either a peripherally inserted central catheter [PICC] or a subcutaneously implanted port) was placed at diagnosis. Patients were enrolled at Children's Hospital Los Angeles from September 2012 until July 2015. None of the patients had a known past medical or family history of thrombosis or bleeding or clotting disorders and none were taking any medications (other than induction chemotherapy) that could affect coagulation (e.g. NSAIDs). Patients had complete blood counts (CBC), TEG, and markers of thrombin generation (quantitative D-dimers, thrombin:antithrombin complexes, and prothrombin fragment 1.2) performed before initiation of treatment and then once weekly during induction until they either presented with a symptomatic VTE or completed Induction therapy. All patients had a Doppler ultrasound of the extremity in which their central venous catheter was placed at the end of induction or at presentation with symptoms suggesting thrombosis. Results: Eighty patients have been enrolled (see Table 1 for demographics) with 72 being fully evaluable currently. Three (4.3%) patients developed symptomatic VTE and 7 (15%) patients had an asymptomatic VTE for an overall incidence of VTE of 21.7%. We demonstrate that R time gradually increases over time from baseline during induction therapy. Additionally, maximum amplitude (MA) is initially diminished, but then increases with time. There were no statistically significant differences in VTE incidence between males and females, different age groups (though there was a trend towards increased incidence for older children), or CVC type (none of the patients with an implanted port had a VTE). Interestingly, MA did not seem to be associated with platelet count. Conclusion: Patients in this prospective study of patients with newly diagnosed ALL during induction at a single institution show rates of thrombosis in patients with ALL similar to that in the literature. Furthermore, TEG results demonstrated a shortening of the clotting time (R) and an increase in the clot rigidity (MA) during induction. Though not statistically significant, older children and patients with HR-ALL were more likely to have a VTE. Additional analyses will be performed to investigate the ability of the TEG, as well as the CBC and markers of thrombin generation, in predicting the development of VTE in these patients. Table 1. Patient Demographics Patient Demographics Gender Female 33 (46%) Male 38 (54%) Age < 5 years 28 (39%) 9-12 years 26 (37%) 10+ years 17 (24%) Patient VTE classification Symptomatic VTE 3 (4%) Asymptomatic VTE 12 (17%) No VTE 56 (79%) Demographics by CVC Type Type of CVC PICC Port-a-Cath Total Gender Female 35 (45%) 3 (100%) 38 (48%) Male 42 (55%) 0 (0%) 42 (53%) Age < 5 years 29 (38%) 2 (67%) 31 (39%) 9-12 years 30 (39%) 0 (0%) 30 (38%) 10+ years 18 (23%) 1 (33%) 19 (24%) Type of ALL SR-ALL 54 (70%) 0 (0%) 54 (68%) HR-ALL 23 (30%) 2 (67%) 25 (31%) T-ALL 0 (0%) 1 (33%) 1 (1%) Patient VTE classification Symptomatic VTE 3 (4%) 0 (0%) 3 (4%) Asymptomatic VTE 12 (17%) 0 (0%) 12 (17%) No VTE 54 (78%) 2 (100%) 56 (79%) Patient VTE classification Demographics by VTE Symptomatic VTE Asymptomatic VTE No VTE Total Gender Female 1 (33%) 7 (58%) 25 (45%) 33 (46%) Male 2 (67%) 5 (42%) 31 (55%) 38 (54%) Age categories < 5 years 1 (33%) 4 (33%) 23 (41%) 28 (39%) 9-12 years 0 (0%) 3 (25%) 23 (41%) 26 (37%) 10+ years 2 (67%) 5 (42%) 10 (18%) 17 (24%) Type of ALL SR-ALL 1 (33%) 7 (58%) 39 (70%) 47 (66%) HR-ALL 2 (67%) 5 (42%) 16 (29%) 23 (32%) T-ALL 0 (0%) 0 (0%) 1 (2%) 1 (1%) Figure 1. Figure 1. Figure 2. Figure 2. Disclosures Ko: Alexion: Honoraria; NovoNordisk: Consultancy. Young:Bayer: Consultancy; Kedrion: Consultancy; Novo Nordisk: Consultancy, Honoraria; Baxter: Consultancy; Biogen Idec: Consultancy, Honoraria.

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