Central venous catheter-related infections in hematology and oncology : guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).
Catheter-related infections (CRI) cause considerable morbidity in hospitalized patients. The incidence does not seem to be higher in neutropenic patients than in nonneutropenic patients. Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the pathogens most frequently cultured, followed by Candida species. Positive blood cultures are the cornerstone in the diagnosis of CRIs, while local signs of infection are not necessarily present. Blood cultures should be taken from peripheral blood and from the venous catheter. A shorter time to positivity of catheter blood cultures as compared with peripheral blood cultures supports the diagnosis of a CRI. In many cases, a definite diagnosis requires catheter removal and microbiological analysis. The role plate method with semiquantitative cultures has been established as standard in most laboratories. Antimicrobial treatment of CRI should be directed by the in vitro susceptibility of the isolated pathogen. Primary removal of the catheter is mandatory in S. aureus and Candida infections, as well as in case of tunnel or pocket infections. Future studies will elucidate whether the rate of CRI in neutropenic patients may be reduced by catheters impregnated with antimicrobial agents.
Wolf
Hans-Heinrich
HH
Klinik für Innere Medizin IV, Onkologie, Hämatologie und Hämostaseologie, Martin-Luther-Universität Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany. hans.wolf@medizin.uni-halle.de
Leithäuser
Malte
M
Maschmeyer
Georg
G
Salwender
Hans
H
Klein
Ulrike
U
Chaberny
Iris
I
Weissinger
Florian
F
Buchheidt
Dieter
D
Ruhnke
Markus
M
Egerer
Gerlinde
G
Cornely
Oliver
O
Fätkenheuer
Gerd
G
Mousset
Sabine
S
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000592:standards*; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D008828:Microbiological Techniques / Q000592:standards
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents