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Outcomes of Hickman Catheter Salvage in Febrile Neutropenic Cancer Patients With Staphylococcus aureus Bacteremia

Published online by Cambridge University Press:  02 January 2015

Sung-Han Kim ,
Cheol-In Kang ,
Hong-Bin Kim ,
Sung-Soo Youn ,
Myoung-don Oh ,
Eui-Chong Kim ,
Seon-Yang Park ,
Byoung-Kook Kim  and
Kang-Won Choe
Sung-Han Kim
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Cheol-In Kang
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Hong-Bin Kim
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Sung-Soo Youn
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Myoung-don Oh*
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
Eui-Chong Kim
Affiliation:
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
Seon-Yang Park
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Byoung-Kook Kim
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Kang-Won Choe
Affiliation:
Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
*
Department of Internal Medicine, Seoul National University Hospital, 28 Youngun-dong, Chongro-gu, Seoul, Republic of Korea, 110-744
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Abstract

Objective:

To evaluate the outcome of attempted Hickman catheter salvage in neutropenic cancer patients with Staphylococcus aureus bacteremia who were not using antibiotic lock therapy.

Design:

Retrospective cohort study.

Setting:

A university-affiliated, tertiary-care hospital with 1,500 beds for adult patients.

Patients:

All neutropenic cancer patients who had a Hickman catheter andS. aureus bacteremia (32 episodes in 29 patients) between January 1998 and March 2002.

Methods:

Salvage attempts were defined as cases where the Hickman catheter was not removed until we obtained the results of follow-up blood cultures performed 48 to 72 hours after starting treatment with antistaphylococcal antibiotics. Salvage was considered to be successful if the Hickman catheter was still in place 3 months later without recurrent bacteremia or death.

Results:

Catheter salvage was attempted in 24 (75%) of the 32 episodes. Of the salvage attempts, the success rate was 50% (12 of 24). Salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures, and in 65% (11 of 17) of those with negative follow-up blood cultures (P = .07). If the analysis is confined to cases with no external signs of catheter infection, salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures and in 80% (8 of 10) of those with negative follow-up blood cultures (P = .02).

Conclusion:

In neutropenic cancer patients with S. aureus bacteremia, attempted catheter salvage without antibiotic lock therapy was successful in 50% of the cases.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 897 - 904
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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References

1. Yip, C, Rotstein, C. Hickman catheter-related infections in patients with cancer. Int J Antimicrob Agents 1998;10:181–189.10.1016/S0924-8579(98)00038-7Google Scholar
2. Groeger, JS, Lucas, AB, Thaler, HT, et al. Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Intern Med 1993;119:1168–1174.10.7326/0003-4819-119-12-199312150-00003Google Scholar
3. Hughes, WT, Armstrong, D, Bodey, GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730–751.10.1086/339215Google Scholar
4. Gonzalez-Barca, E, Fernandez-Sevilla, A, Carratala, J, et al. Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institution. Eur J Clin Microbiol Infect Dis 1996;15:291–296.10.1007/BF01695660Google Scholar
5. Press, OW, Ramsey, PG, Larson, EB, et al. Hickman catheter infections in patients with malignancies. Medicine 1984;64:189–200.10.1097/00005792-198407000-00001Google Scholar
6. Dugdale, DC, Ramsey, PG. Staphylococcus aureus bacteremia in patients with Hickman catheters. Am J Med 1990;89:137–141.10.1016/0002-9343(90)90290-TGoogle Scholar
7. Mermel, LA, Farr, BM, Sherertz, RJ, et al. Guidelines for the management of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2001;22:222–242.10.1086/501893Google Scholar
8. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Villanova, PA: National Committee for Clinical Laboratory Standards; 1993. Approved standard M2-A5.Google Scholar
9. Soriano, A, Martinez, JA, Mensa, J, et al. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368–373.10.1086/313650Google Scholar
10. Marr, KA, Sexton, DJ, Conlon, PJ, Corey, GR, Schwab, SJ, Kirkland, KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997;127:275–280.10.7326/0003-4819-127-4-199708150-00003Google Scholar
11. Petersen, FB, Clift, RA, Hickman, RO, et al. Hickman catheter complications in marrow transplant recipients. JPEN J Parenter Enteral Nutr 1985;10:58–62.10.1177/014860718601000158Google Scholar
12. Hiemenz, J, Skelton, J, Pizzo, PA. Perspective on the management of catheter-related infections in cancer patients. Pediatr Infect Dis 1986;5:6–11.10.1097/00006454-198601000-00002Google Scholar
13. Johnson, PR, Decker, MD, Edwards, KM, et al. Frequency of Broviac catheter infections in pediatric oncology patients. J Infect Dis 1986;154:570–578.10.1093/infdis/154.4.570Google Scholar
14. Benezra, D, Kiehn, TE, Gold, JW, et al. Prospective study of infections in indwelling central venous catheters using quantitative blood cultures. Am J Med 1988;85:495–498.10.1016/S0002-9343(88)80084-6Google Scholar
15. Mirro, J, Rao, BN, Stokes, DC, et al. A prospective study of Hickman/Broviac catheters and implantable ports in pediatric oncology patients. J Clin Oncol 1989;7:214–222.10.1200/JCO.1989.7.2.214Google Scholar
16. Ulz, L, Petersen, FB, Ford, R, et al. A prospective study of complications in Hickman right-atrial catheters in marrow transplant patients. JPEN J Parenter Enteral Nutr 1990; 14:27–30.10.1177/014860719001400127Google Scholar
17. Rotstein, C, Brock, L, Roberts, RS. The incidence of first Hickman catheter-related infection and predictors of catheter removal in cancer patients. Infect Control Hosp Epidemiol 1995;16:451–458.10.2307/30141082Google Scholar
18. Elishoov, H, Or, R, Strauss, N, et al. Nosocomial colonization, septicemia, and Hickman/Broviac catheter-related infections in bone marrow transplant recipients. Medicine 1998;77:83–101.10.1097/00005792-199803000-00002Google Scholar
19. Lecciones, JA, Lee, JW, Navarro, EE, et al. Vascular catheter-related fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis 1992;14:975–983.10.1093/clinids/14.4.875Google Scholar
20. Siegman-Igra, Y, Anglim, AM, Shapiro, DE, et al. Diagnosis of vascular catheter-related bloodstream infection: meta-analysis. J Clin Microbiol 1997;35:928–936.10.1128/jcm.35.4.928-936.1997Google Scholar
21. Flynn, PM, Shenep, JL, Barrett, FF. Differential quantitation with a commercial blood culture tube for diagnosis of catheter-related infection. J Clin Microbiol 1998;26:1045–1046.10.1128/jcm.26.5.1045-1046.1988Google Scholar
22. Capdevila, JA, Planes, AM, Palomar, M, et al. Value of differential quantitative blood cultures in the diagnosis of catheter-related sepsis. Eur J Clin Microbiol Infect Dis 1992;11:403–407.10.1007/BF01961854Google Scholar
23. Blot, F, Nitenberg, G, Chachaty, E, et al. Diagnosis of catheter-related bacteremia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 1999;354:1071–1077.10.1016/S0140-6736(98)11134-0Google Scholar
24. Pearson, ML. Hospital Infection Control Practices Advisory Committee (HICPAC): guideline for prevention of intravascular-device-related infections. Infect Control Hosp Epidemiol 1996;17:438–473.Google Scholar
25. Capdevila, JA, Segarra, A, Planes, AM, et al. Successful treatment of hemodialysis catheter-related sepsis without catheter removal. Nephrol Dial Transplant 1993;8:231–234.Google Scholar
26. Berrington, A, Could, FK. Use of antibiotics locks to treat colonized central venous catheters. J Antimicrob Chemother 2001;48:597–603.10.1093/jac/48.5.597Google Scholar