title: Incidence of and risk factors for persistent gram-positive bacteraemia and catheter-related thrombosis in haematopoietic stem cell transplantation.
abstract: A cohort of 439 haematopoietic SCT recipients was analysed to determine the incidence of Gram-positive coccal bacteraemia and thromboembolic events associated with the use of central venous catheters (CVCs) and to determine risk factors for these complications. The incidences of persistent coagulase-negative staphylococcal (CoNS) bacteraemia, symptomatic thrombosis and thrombophlebitis were 25%, 9.6% and 6.6%, respectively. Duration of neutropenia (in days, odds ratio (OR) 1.02; P=0.04) and left-sided placement of the CVCs (OR 1.73; P=0.03) were independent risk factors for the occurrence of persistent CoNS bacteraemia, whereas the use of less mucotoxic conditioning regimens was associated with a lower risk (high-dose melphalan (HDM)/BEAM vs other regimens, OR 0.24; P<0.001). Use of TBI, persistent CoNS bacteraemia and tip colonisation were all significantly associated with an increased risk of symptomatic thrombosis (OR 6.03, 3.36 and 2.80, respectively; P0.02). The risk factors found in this cohort of SCT recipients differed from those found in the general cancer population, showing an important role for persisting bacteraemia in the pathogenesis of CVC-associated thrombosis. Therefore, we constructed a new algorithm in order to improve catheter management and prevent these CVC-related complications.
authors.affiliation: Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Richters
authors.affiliation: Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Vliet
authors.affiliation: Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: P G M
authors.initials: PG
authors.lastname: Peer
authors.affiliation: 1] Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands [2] Department of Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: P E
authors.initials: PE
authors.lastname: Verweij
authors.affiliation: Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: B A P
authors.initials: BA
authors.lastname: Laros-van Gorkom
authors.affiliation: 1] Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands [2] Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: N M A
authors.initials: NM
authors.lastname: Blijlevens
authors.affiliation: 1] Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands [2] Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Donnelly
authors.affiliation: 1] Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands [2] Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: W J F M
authors.initials: WJ
authors.lastname: van der Velden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006094:Gram-Positive Bacteria / Q000472:pathogenicity*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology*; D019172:Transplantation Conditioning / Q000009:adverse effects*; D055815:Young Adult