Outcomes of Hickman catheter salvage in febrile neutropenic cancer patients with Staphylococcus aureus bacteremia.
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.


METHODS
Retrospective cohort study.


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


METHODS
All neutropenic cancer patients who had a Hickman catheter and S. 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).


CONCLUSIONS
In neutropenic cancer patients with S. aureus bacteremia, attempted catheter salvage without antibiotic lock therapy was successful in 50% of the cases.
Kim
Sung-Han
SH
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Kang
Cheol-In
CI
Kim
Hong-Bin
HB
Youn
Sung-Soo
SS
Oh
Myoung-don
MD
Kim
Eui-Chong
EC
Park
Seon-Yang
SY
Kim
Byoung-Kook
BK
Choe
Kang-Won
KW
D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000382:microbiology*; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D020878:Device Removal; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000601:surgery; D009503:Neutropenia / Q000150:complications* / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000187:drug effects
D000900:Anti-Bacterial Agents