title: Prospective surveillance study of blood stream infections associated with central venous access devices (port-type) in children with acute leukemia: an intervention program.
abstract: The use of intensive chemotherapy and central devices has improved patients survival, but it is associated with catheter-related blood-stream infections (CRBSI). An educational program was instituted for preventing CRBSI occurrence in acute leukemia pediatric patients having totally implanted central devices. The Centers of Disease Control and Prevention criteria were used as definition for CRBSI. Data collected were age, sex, diagnosis, chemotherapy, inpatient versus outpatient, microbiological data, risk factors, social risk score, and treatment performed. CRBSI rate decreased from 6.7 to 3.7/1000 catheter-days with preventive measures (P=0.05). A further decrease to 1.5/1000 catheter-days was reached after the intensification of the educational program (P=0.01). Severe neutropenia at the time of catheter insertion was related to CRBSI and to infection recurrence (P<0.05). Most of the episodes occurred during induction chemotherapy. Thirty-six CRBSI episodes occurred in 25 of 73 patients. The most frequent microorganism isolated was Staphylococcus spp. Antibiotherapy was successful in 83.3% of episodes. Six patients needed a central venous access device replacement. Our intervention program was successful to decrease the CRBSI rates and its intensification allowed a further decrease, approaching reported rates in this setting. Severe neutropenia at the time of central venous access device insertion was related to CRBSI occurrence and recurrence.
authors: Department of Pediatric Hematology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain. rberrueco@hjsdbcn.org
authors: Rubén
authors: R
authors: Berrueco
authors: Susana
authors: S
authors: Rives
authors: Albert
authors: A
authors: Català
authors: Teresa
authors: T
authors: Toll
authors: Amadeu
authors: A
authors: Gene
authors: Anna
authors: A
authors: Ruiz
authors: Ramón
authors: R
authors: Badosa
authors: Maria A
authors: MA
authors: Claramonte
authors: Jesús
authors: J
authors: Estella
authors: Mireya
authors: M
authors: Urrea
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000517:prevention & control / Q000635:transmission; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000295:instrumentation / Q000379:methods*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D007938:Leukemia / Q000188:drug therapy*; D008297:Male; D009726:Nurses; D010820:Physicians; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents