Abstract
Introduction
The use of central venous (CV) catheters is crucial for administering chemotherapy to children; however, catheter-related bacterial infections can be life threatening. The guidelines of Centers for Disease Control (CDC) and Prevention recommend ensuring sterile access to CV catheters by scrubbing the access port with an appropriate antiseptic, such as chlorhexidine, povidone-iodine, or 70% alcohol, and accessing the port only with sterile devices. For pediatric patients receiving chemotherapy, our institution uses the Hickman catheter as a CV catheter. Between April 2008 and March 2010, 83% alcohol was used to sterilize the access port. Because a large number of patients acquired subsequent infections including with Bacillus cereus, we used 10% povidone-iodine before accessing the catheter between April 2010 and March 2012. We compared the rates of bacterial infections during these two periods.
Patients and Methods
We performed blood cultures of patients receiving chemotherapy using venous puncture or a CV catheter before starting antibiotics. We determined the number of positive cultures, identified the infectious agent, and clinically evaluated the infected patients. Between April 2008 and March 2010, we investigated297 patients, of which 207 were treated using CV catheters. The median age of the 207 patients (129 males and 78 females) was 8 years (range, 2 months to 30 years). The indications for chemotherapy included stem-cell transplantation to treat the diseases as follows: hematological malignancies (n=127), malignant solid tumors (n=62), and congenital immune deficiencies (n=18). Between April 2010 and March 2012, we investigated 291 patients, of which 185 were treated using CV catheters. The median age of the 185 patients (129 males and 56 females) was 6 years (range, 10 months to 16 years). The indications for chemotherapy included the following conditions: hematological malignancies (n=98), malignant solid tumors (n=81), pure red-cell aplasia (n=4), and congenital immune deficiencies (n=2).
We defined catheter-associated bloodstream infection by detection of common commensal pathogens, such as Staphylococcus species and Bacillus cereus, according to the definitions of the CDC/NHSN along with detection of pathogens from cultures collected from the access port of the CV catheter.
Results
There was no significant difference between the two groups in patient characteristics such as median age and the period of neutropenia. The frequency of positive blood cultures were 16.4% (34/207) and 11.9% (22/185) (p = 0.224) for the former and latter periods, respectively. In the first period, 61.8% (21/34) of the pathogens isolated were gram-positive (e.g., S. epidermidis) and 41.2% (14/34) were gram-negative (e.g., B cereus). Our definition of catheter-associated bloodstream infection was met by 12.6% (26/207) in these cases. In the second period, 40.9% (9/22) of the pathogens isolated were gram-positive and 40.9% (9/23) were gram-negative (e.g., Enterobacter cloacae). Our definition of catheter-associated bloodstream infection was met by 6.5% (12/185) (p = 0.0658) Notably, B. cereus was not detected in the second period.
Conclusion
Sterilization of the access port of CV catheters using povidone-iodine decreased catheter-associated bloodstream infection. A significant advantage of using povidone-iodine was eliminating infections with the fatal pathogen, B. cereus.
Disclosures:
No relevant conflicts of interest to declare.
Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection
