Factors influencing catheter-related infections in the Dutch multicenter study on high-dose chemotherapy followed by peripheral SCT in high-risk breast cancer patients.
Neutropenia following high-dose chemotherapy leads to a high incidence of infectious complications, of which central venous catheter-related infections predominate. Catheter-related infections and associated risk factors in 392 patients participating in a randomized adjuvant breast cancer trial and assigned to receive high-dose chemotherapy and peripheral stem-cell reinfusion were evaluated. Median catheter dwell time was 25 days (range 1-141). Catheter-related infections were seen in 28.3% of patients (11 infections per 1000 catheter-days). Coagulase-negative staphylococci were found in 104 of 186 positive blood cultures (56%). No systemic fungal infections occurred. Cox regression analysis showed that duration of neutropenia >10 days (P=0.04), using the catheter for both stem-cell apheresis and high-dose chemotherapy (P= <0.01), and use of total parenteral nutrition (TPN, P=0.04) were predictive for catheter-related infections. In conclusion, a high incidence of catheter-related infections after high-dose chemotherapy was seen related to duration of neutropenia, use of the catheter for both stem-cell apheresis and high-dose chemotherapy, and use of TPN. Selective use and choice of catheters could lead to a substantial reduction of catheter-related infectious complications.
Nieboer
P
P
Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
de Vries
E G E
EG
Mulder
N H
NH
Rodenhuis
S
S
Bontenbal
M
M
van der Wall
E
E
van Hoesel
Q G
QG
Smit
W M
WM
Hupperets
P
P
Voest
E E
EE
Nooij
M A
MA
Boezen
H M
HM
van der Graaf
W T A
WT
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D009426:Netherlands; D009503:Neutropenia / Q000209:etiology; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000970:Antineoplastic Agents