title: Catheter-associated bloodstream infections in pediatric hematology-oncology patients: factors associated with catheter removal and recurrence.
abstract: The aims of this study were to analyze the factors associated with antibiotic failure leading to tunneled central venous catheter (CVC) removal during catheter-associated bloodstream infections (CABSIs) and with recurrence and reinfection in children with cancer. All cases of CABSI in patients attending the Department of Pediatric Hematology-Oncology between November 2000 and November 2003 were reviewed. A total of 207 episodes of CABSI, including multiple episodes involving the same catheter, were identified in 146 of 410 tunneled CVCs (167 Hickman, 243 implantable ports). The most common organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in 96 (46%) episodes. Hypotension, persistent bacteremia, previous stem cell transplantation, multiple CABSIs in the same CVC, exit-site infection, inappropriate empiric antibiotic therapy, and Candida infection were all significantly associated with increased risk of catheter removal (P < 0.05, odds ratios 7.81, 1.14, 2.22, 1.93, 3.04, 2.04 and 24.53, respectively). There were 12 episodes of recurrent infection, all except 1 caused by CONS (odds ratio 20.5, P = 0.006). Inappropriate empiric therapy, especially in implantable ports, was the only mutable risk factor for antibiotic failure. Because CONS was the predominant isolate in these devices, adding glycopeptides to the empiric therapy for suspected implantable-port CABSI might decrease the removal rate. This issue should be explored in future controlled trials.
authors.affiliation: Unit of Pediatric Infectious Diseases and Hospital Infection Control, Schneider Children's Medical Center of Israel, Jerusalem. netaadle@post.tau.acil
authors.forename: Amos
authors.initials: A
authors.lastname: Adler
authors.forename: Isaac
authors.initials: I
authors.lastname: Yaniv
authors.forename: Ester
authors.initials: E
authors.lastname: Solter
authors.forename: Enrique
authors.initials: E
authors.lastname: Freud
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.forename: Jerry
authors.initials: J
authors.lastname: Stein
authors.forename: Salvador
authors.initials: S
authors.lastname: Fisher
authors.forename: Itzhak
authors.initials: I
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000209:etiology*; D002177:Candidiasis / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006402:Hematologic Diseases / Q000150:complications* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology