title: Role of Broviac catheters in infections in children with cancer.
abstract: In a 3-year period 157 single lumen Broviac catheters were inserted in 145 children with various neoplastic diseases. The overall duration of the catheter courses was 30,533 days (median, 171; range, 2 to 647). Sixty-five percent of the catheter courses (102 of 157) were complicated by at least 1 febrile episode, for a total of 157 episodes. According to European Organization for Research on Treatment of Cancer criteria, 79 febrile episodes (50%) were classified as microbiologically documented infections, 57 (36%) with and 22 (14%) without septicemia; 31 (20%) as clinically documented infections; and 47 (30%) as possible infections. Of the 79 microbiologically documented infections 21 were catheter-related infections (CRI), 32 were catheter-unrelated infections and 26 were infections of unknown source. Only 48% of CRI occurred during neutropenia (less than 1000 neutrophils/mm3), compared with 88% of catheter-unrelated infections and 96% of infections of unknown origin (P = 0.00007). Gram-positive microorganisms (56% staphylococci) accounted for 78% of all isolates in CRI, 47% in catheter-unrelated infections and 43% in infections of unknown origins (P = 0.03). Fungi represented 12% of all isolates. Clinical and microbiologic resolution without removal of the catheter was achieved in 12 of 21 CRI (57%) and no patient died from a CRI. This study indicates that over 3 of 4 of CRI are caused by Gram-positive bacteria, occur in neutropenic and non-neutropenic patients (approximately 50%) and can be successfully treated without removing the catheter.
authors.affiliation: Department of Infectious Disease, University of Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
authors.forename: A
authors.initials: A
authors.lastname: Garaventa
authors.forename: L
authors.initials: L
authors.lastname: Boni
authors.forename: A
authors.initials: A
authors.lastname: Melodia
authors.forename: G
authors.initials: G
authors.lastname: Dini
authors.forename: R
authors.initials: R
authors.lastname: Cuneo
authors.forename: A
authors.initials: A
authors.lastname: Rizzo
authors.forename: C
authors.initials: C
authors.lastname: Moroni
authors.forename: D
authors.initials: D
authors.lastname: Rogers
authors.forename: B
authors.initials: B
authors.lastname: De Bernardi
mesh_terms: D000293:Adolescent; D000380:Agranulocytosis / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000382:microbiology*; D009894:Opportunistic Infections / Q000382:microbiology*; D018805:Sepsis / Q000382:microbiology