title: Hickman catheter-related infections in neutropenic patients: insertion in the operating theater versus insertion in the radiology suite.
abstract: OBJECTIVE
  To determine the influence of microbial air quality during Hickman catheter insertion in the operating theater versus insertion in the radiology suite on the incidence of catheter-related infections (CRIs).
  
  
  METHODS
  Hemato-oncologic patients with prolonged neutropenia on antimicrobial prophylaxis were entered onto the study. Catheters were inserted by experienced radiologists under sonographic and fluoroscopic guidance.
  
  
  RESULTS
  Forty-eight Hickman catheters in 39 patients were inserted (23 in the operating theater, 25 in the radiology suite). CRIs were seen in 16 catheters (33%; six per 1,000 catheter days; eight in each group). Local infections were found in nine catheters (22%; six in the operating theater v three in the radiology suite; not significant [NS]), catheter-related bacteremia was found in 10 (29%; three in the operating theater v seven in the radiology suite; NS). Coagulase-negative staphylococci (CoNS) caused all CRIs. Despite early vancomycin therapy, 11 (69%; four in the operating room group v seven in the radiology suite group; NS) of the catheters with CRIs had to be removed prematurely. At 90 days after insertion, catheter survival was 78% and 60% (NS) for the operating room and radiology suite, respectively. Multivariate analysis showed that neutropenia increased the CRI risk 20-fold (P =.004) and was strongly related to premature catheter removal owing to infection (relative risk = 11.9; P =.009). Neutropenia on the day of insertion was also significantly correlated with CRI (P =.04) and premature catheter removal owing to infection (P =.03). Serial cultures of blood, exit site, and catheter hub did not predict the development of CRI.
  
  
  CONCLUSIONS
  The high incidence of Hickman CRI caused by CoNS was not associated with insertion location (operating theater v radiology suite). Neutropenia, including neutropenia on the day of insertion, was a significant risk factor for CRI and infection-related catheter removal.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands. nouwen@bacl.azr.nl
authors.forename: J L
authors.initials: JL
authors.lastname: Nouwen
authors.forename: J J
authors.initials: JJ
authors.lastname: Wielenga
authors.forename: H
authors.initials: H
authors.lastname: van Overhagen
authors.forename: J S
authors.initials: JS
authors.lastname: Laméris
authors.forename: J A
authors.initials: JA
authors.lastname: Kluytmans
authors.forename: M D
authors.initials: MD
authors.lastname: Behrendt
authors.forename: W C
authors.initials: WC
authors.lastname: Hop
authors.forename: H A
authors.initials: HA
authors.lastname: Verbrugh
authors.forename: S
authors.initials: S
authors.lastname: de Marie
mesh_terms: D000328:Adult; D000368:Aged; D000391:Air Microbiology; D019072:Antibiotic Prophylaxis; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000150:complications; D016016:Proportional Hazards Models; D015642:Radiology, Interventional; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology*; D018709:Statistics, Nonparametric
chemical_list: D000970:Antineoplastic Agents