Early ultrasonographic finding of septic thrombophlebitis is the main indicator of central venous catheter removal to reduce infection-related mortality in neutropenic patients with bloodstream infection.
BACKGROUND
Septic thrombophlebitis increases patient morbidity and mortality following metastatic infections, pulmonary emboli, and/or septic shock. Central venous catheter (CVC) removal for occult septic thrombophlebitis challenges current strategy in neutropenic patients.


METHODS
We prospectively evaluated infection-related mortality in 100 acute leukemia patients, with CVC-related bloodstream infection (CRBSI) after chemotherapy, who systematically underwent ultrasonography to identify the need for catheter removal. Their infection-related mortality was compared with that of a historical cohort of 100 acute leukemia patients, with CRBSI after chemotherapy, managed with a clinically driven strategy. Appropriate antimicrobial therapy was administered in all patients analyzed.


RESULTS
In the prospective series, 30/100 patients required catheter removal for ultrasonography-detected septic thrombophlebitis after 1 median day from BSI onset; 70/100 patients without septic thrombophlebitis retained their CVC. In the historical cohort, 60/100 patients removed the catheter (persistent fever, 40 patients; persistent BSI, 10 patients; or clinically manifest septic thrombophlebitis, 10 patients) after 8 median days from BSI onset; 40/100 patients retained the CVC because they had not clinical findings of complicated infection. At 30 days median follow-up, one patient died for infection in the ultrasonography-assisted group versus 17 patients in the historical cohort (P<0.01). With the ultrasonography-driven strategy, early septic thrombophlebitis detection and prompt CVC removal decrease infection-related mortality, whereas clinically driven strategy leads to inappropriate number, reasons, and timeliness of CVC removal.


CONCLUSIONS
Ultrasonography is an easy imaging diagnostic tool enabling effective and safe management of patients with acute leukemia and CRBSI.
Departments of Biochemistry and Medical Biotechnology.
M
M
Picardi
Departments of Biochemistry and Medical Biotechnology.
S
S
Pagliuca
Departments of Biochemistry and Medical Biotechnology.
F
F
Chiurazzi
Cellular and Molecular Biology and Pathology, Federico II University Medical School, Naples, Italy.
D
D
Iula
Cellular and Molecular Biology and Pathology, Federico II University Medical School, Naples, Italy.
M
M
Catania
Cellular and Molecular Biology and Pathology, Federico II University Medical School, Naples, Italy.
F
F
Rossano
Departments of Biochemistry and Medical Biotechnology. Electronic address: fabpane@unina.it.
F
F
Pane
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D055499:Catheter-Related Infections / Q000000981:diagnostic imaging* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D016469:Fungemia / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000097:blood / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000382:microbiology; D012189:Retrospective Studies; D013924:Thrombophlebitis / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology / Q000382:microbiology; D014463:Ultrasonography; D055815:Young Adult