title: Central venous catheter-associated bloodstream infections in pediatric hematology-oncology patients and effectiveness of antimicrobial lock therapy.
abstract: BACKGROUND
  Central line-associated bloodstream infection (CLABSI) is a serious complication in hematology-oncology patients. This study aimed to analyze the prevalence of CLABSI and the effectiveness of antimicrobial lock therapy (ALT) in pediatric patients.
  
  
  METHODS
  BSIs of all pediatric hematology-oncology patients admitted to a children's hospital between January 2009 and December 2013 were reviewed. The United States National Healthcare Safety Network and Infectious Diseases Society of America guidelines were used to define CLABSI and catheter-related BSI (CRBSI). The incidence, laboratory and microbiology characteristics, poor outcome, and effectiveness of ALT were analyzed.
  
  
  RESULTS
  There were 246 cases of CLABSI in 146 patients (mean age, 10.0 years), including 66 (26.8%) cases of CRBSI. The incidence of CLABSI was 4.49/1000 catheter-days, and the infection was responsible for 32.9% of the complications these patients developed and 9.3% of contributable mortality. Patients with acute myeloid leukemia had the highest infection density (5.36/1000 patient-days). Enterobacteriaceae (40.2%) and coagulase-negative staphylococci (CoNS; 20.7%) were the predominant pathogens. In multivariate analysis, older age, male sex, elevated C-reactive protein, acute lymphoblastic leukemia, and candidemia were associated with poor outcome. The success rate of ALT was 58.6% (17/29) for the treatment of CoNS and 78.3% (29/37) for Enterobacteriaceae infections. Patients with candidemia (n = 18) had the highest mortality (33.4%) and catheter removal rate (66.7%). Chlorhexidine as the disinfectant decreased the 1-year CLABSI rate from 13.7/1000 to 8.4/1000 catheter-days (p = 0.02).
  
  
  CONCLUSIONS
  CoNS and Enterobacteriaceae are the predominant pathogens in CLABSI among pediatric hematology-oncology patients. ALT is effective and showed no significant side effect. New disinfection practice and infection control measures can decrease CLABSI.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, New Taipei City Hospital, New Taipei City, Taiwan.
authors.forename: Hsing-Chen
authors.initials: HC
authors.lastname: Tsai
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ping-Ing
authors.initials: PI
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Jong-Ming
authors.initials: JM
authors.lastname: Chen
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Pei-Lan
authors.initials: PL
authors.lastname: Shao
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.affiliation: Center for Infection Control, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.affiliation: Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: cylu@ntu.edu.tw.
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism; D058387:Candidemia / Q000453:epidemiology / Q000382:microbiology; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000494:pharmacology; D004202:Disinfectants / Q000494:pharmacology; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D017053:Infection Control; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013210:Staphylococcus / Q000302:isolation & purification
chemical_list: D000890:Anti-Infective Agents; D004202:Disinfectants; D002097:C-Reactive Protein; D002710:Chlorhexidine
keywords: antimicrobial lock therapy; bloodstream infection; central catheter; hematology–oncology; pediatric