title: Catheter-related bloodstream infection with removal of catheter in pediatric oncology patients: a 10-year experience in Taiwan.
abstract: BACKGROUND
  Long-term central venous catheter (CVC) implantation has become more affordable in Taiwan since 1995. Surgical removal of the catheter may be the essential treatment for catheter-related bloodstream infections (CRBSI). The aim of this study was to evaluate the clinical features and microbial isolates in pediatric cancer patients with removal of CVC for CRBSI.
  
  
  METHODS
  The records of positive blood culture from hospitalized pediatric oncology patients between 1995 and 2004 were reviewed. One hundred and forty-three patients implanted with a long-term CVC were further identified.
  
  
  RESULTS
  Seventeen catheters in 16 patients developed catheter-related bacteremia that needed catheter removal. The rate of catheter removal was 11.9%. The median device life was 7.7 months. Six catheters were removed within 3 months of insertion. Nine of the 17 catheters were removed from patient younger than 2 years. Eight infections occurred during severe neutropenia, and 6 patients had refractory or relapsed underlying disease. The cultural isolates were Gram-negative bacilli in 7, Gram-positive in 5, fungi in 5, and atypical mycobacterium in 1. The frequency of catheter removal for infection control was significantly higher in the first 5 years (1994-1999) compared to the last 5 years (2000-2004) (30.9 vs. 4.0%, p = 2.3 × 10(-4)).
  
  
  CONCLUSIONS
  Factors such as microbiological isolates, age of infection, the status of malignancy, and neutropenia are related to catheter outcome. The reduction in patients with positive cultures needing removal of the catheters can be related to improved nursing care and more aggressive antibiotic therapy.
authors.affiliation: Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin Street, Kuei Shan 333, Taoyuan, Taiwan.
authors.forename: Shih-Hsiang
authors.initials: SH
authors.lastname: Chen
authors.forename: Chao-Ping
authors.initials: CP
authors.lastname: Yang
authors.forename: Tang-Her
authors.initials: TH
authors.lastname: Jaing
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
authors.forename: Iou-Jih
authors.initials: IJ
authors.lastname: Hung
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D055499:Catheter-Related Infections / Q000097:blood* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D009503:Neutropenia / Q000209:etiology / Q000473:pathology; D013624:Taiwan