Unnecessary Removal of Central Venous Catheters in Cancer Patients with Bloodstream Infections

2018 ◽  
Vol 39 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Anne Marie Chaftari ◽  
Ray Hachem ◽  
Sammy Raad ◽  
Ying Jiang ◽  
Elizabeth Natividad ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Cancer Patients ◽  
Vascular Access ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous Catheters ◽  
Infect Control Hosp ◽  
Physician Education ◽  
Central Venous

We evaluated the rate of central venous catheter (CVC) removal in 283 cancer patients with bloodstream infections (BSIs). Removal of CVCs occurred unnecessarily in 57% of patients with non-central-line-associated BSI (non-CLABSI), which was equivalent to the rate of CVC removal in patients with CLABSIs. Physician education and safe interventions to salvage the vascular access are warranted.Infect Control Hosp Epidemiol 2018;39:222–225

scholarly journals Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Johny Fares ◽  
Melissa Khalil ◽  
Anne-Marie Chaftari ◽  
Ray Hachem ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Cancer Patients ◽  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Mucosal Barrier ◽  
Central Venous ◽  
Gram Negative ◽  
Central Venous Catheter Removal ◽  
Mucosal Barrier Injury

Abstract Objective Gram-negative organisms have become a major etiology of bloodstream infections. We evaluated the effect of central venous catheter management on cancer patients with gram-negative bloodstream infections. Method We retrospectively identified patients older than 14 years with central venous catheters who were diagnosed with gram-negative bloodstream infections to determine the effect of catheter management on outcome. Patients were divided into 3 groups: Group 1 included patients with central line-associated bloodstream infections (CLABSI) without mucosal barrier injury and those whose infection met the criteria for catheter-related bloodstream infection; group 2 included patients with CLABSI with mucosal barrier injury who did not meet the criteria for catheter-related bloodstream infection; and group 3 included patients with non-CLABSI. Results The study included 300 patients, with 100 patients in each group. Only in group 1 was central venous catheter removal within 2 days of bloodstream infection significantly associated with a higher rate of microbiologic resolution at 4 days compared to delayed central venous catheter removal (3–5 days) or retention (98% vs 82%, P = .006) and a lower overall mortality rate at 3-month follow-up (3% vs 19%, P = .01). Both associations persisted in multivariate analyses (P = .018 and P = .016, respectively). Conclusions Central venous catheter removal within 2 days of the onset of gram-negative bloodstream infections significantly improved the infectious outcome and overall mortality of adult cancer patients with catheter-related bloodstream infections and CLABSI without mucosal barrier injury.

High success rate in salvage of catheter-related bloodstream infections due to Staphylococcus aureus, on behalf of project group of Italian society of nephrology

2019 ◽  
Vol 21 (3) ◽  
pp. 336-341
Author(s):  
Salvatore Mandolfo ◽  
Adriano Anesi ◽  
Milena Maggio ◽  
Vanina Rognoni ◽  
Franco Galli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Prognostic Index ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Removal ◽  
Renal Unit ◽  
Chronic Haemodialysis ◽  
Central Venous

Background: Catheter-related bloodstream infections caused by Staphylococcus aureus represent one of the most fearful infections in chronic haemodialysis patients with tunnelled central venous catheters. Current guidelines suggest prompt catheter removal in patients with positive blood cultures for S. aureus. This manoeuvre requires inserting a new catheter into the same vein or another one and is not without its risks. Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days. Results: We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by S. aureus, including 19 by methicillin-resistant S. aureus (79% saved) and 21 by methicillin-sensitive S. aureus (90% saved), of which 34 (85%) were treated successfully. Eight recurrences occurred and six (75%) were successfully treated. A greater than 12 h time to blood culture positivity for S. aureus was a good prognostic index for successful therapy and tunnelled central venous catheter rescue. Conclusion: Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by S. aureus and to avoid removing the tunnelled central venous catheter in many more cases than what has been reported in the literature. On the third day, it is mandatory to decide whether to replace the tunnelled central venous catheter or to carry on with antibiotic therapy. Apyrexia and amelioration of laboratory parameters suggest continuing systemic and antibiotic lock therapy for no less than 4 weeks, otherwise, tunnelled central venous catheter removal is recommended.

A Pilot Study of Central Venous Catheter Survival in Cancer Patients Using Low Molecular Weight Heparin (Dalteparin) for the Treatment of Deep Vein Thrombois of the Upper Extremity (UEDVT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 878-878
Author(s):  
Michael J. Kovacs ◽  
Roseann Andreou ◽  
Marc Rodger ◽  
David R. Anderson ◽  
Susan R. Kahn ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Central Venous Catheter ◽  
Thrombolytic Therapy ◽  
Cancer Patients ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous ◽  
Major Hemorrhage ◽  
Recurrent Venous Thromboembolism

Abstract Background: Central venous catheters (e.g., PICC lines and Hickman-type catheters) in patients with cancer are associated with development of DVT in 1–3%. Patient management varies from immediate removal of the line, with or without anticoagulation, to the extreme of thrombolytic therapy. This multicenter cohort clinical trial was designed to assess the safety and effectiveness of a management strategy for central venous catheter-related UEDVT in cancer patients consisting of dalteparin and warfarin as a means of salvaging the line without the need for line removal. Methods: Patients greater than 18 years-of-age with an active malignancy and who had symptomatic, acute, objectively documented UEDVT were eligible. Patients were excluded if the catheter was a dialysis catheter, they had active bleeding or a high risk for major bleeding, platelet count <100 ×09/L, serum creatinine >177μmol/l, if they were currently on therapeutic doses of warfarin, inability to infuse through the catheter after a trial of intraluminal thrombolytic therapy (2mg TPA), had AML or ALL or bone marrow/stem cell transplant planned in the next 3 months or if they did not provided written informed consent. Four centers in Canada participated. Patients were treated with dalteparin 200 IU/kg per day for 5–7 days and simultaneously initiated on warfarin with a target INR of 2.0–3.0. Patients were followed for 3 months for recurrent venous thromboembolism, major hemorrhage and survival of the central venous catheter. Results: There were 74 patients (48 males) enrolled from November 2002 to December 2005. The average age was 58 years. Seventy-one UEDVTs were diagnosed by ultrasound and three by CT. There were 57 PICC lines, 14 portacaths and 3 Hickman catheters. Sixty-four patients (86%) completed three-month follow-up. Of the 10 who did not, 7 died (6 due to cancer and 1 due to a major bleed) and 3 others were no longer evaluable (2 patients were treated with LMWH only and another patient had the line removed against protocol). There were no episodes of recurrent venous thromboembolism and 3 (4%) major bleeds. For the endpoint of line survival, 42 (57%) of the lines were in situ and still functional at three months. No lines were removed due to infusion failure or recurrence/extension of DVT. In the 32 patients who had line removal before the study three-month endpoint, 21 were due to the end of therapeutic need, 2 were due to infection and 9 for other reasons such as falling out, skin irritation, patient request, etc. Hence, 63 (85%) patients were able to maintain the central line until it was no longer needed, or for at least three months. For the 11 others, none were removed due to venous thrombosis or line failure. Conclusion: Treatment of UEDVTs secondary to central catheters in cancer patients with standard dalteparin/warfarin can allow the central line to remain in situ with little risk of line failure or recurrence/extension of the DVT.

Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

2009 ◽  
Vol 28 (3) ◽  
pp. 151-155 ◽  
Author(s):  
Sabra Curry ◽  
Michele Honeycutt ◽  
Gail Goins ◽  
Craig Gilliam
Keyword(s):  
High Risk ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Skin Antisepsis ◽  
Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

Changing Epidemiology of Catheter-Related Bloodstream Infections in Cancer Patients

2018 ◽  
Vol 39 (6) ◽  
pp. 727-729 ◽  
Author(s):  
Anne Marie Chaftari ◽  
Ray Hachem ◽  
Ying Jiang ◽  
Pankil Shah ◽  
Alawami Hussain ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Infect Control Hosp ◽  
Central Venous ◽  
Gram Negative ◽  
Gram Negative Organisms

We compared the etiologic organisms of bloodstream infections (BSIs) in cancer patients with central venous catheters (CVCs) between 2 cohorts separated by more than a decade.Gram-negative organisms have become the predominant etiologic organisms of BSIs (52%); they now contribute to 41% of catheter-related BSIs (CRBSIs).Infect Control Hosp Epidemiol 2018;39:727–729

scholarly journals 120. The Impact of Early Central Venous Catheter Removal in the Management of Enterococcus Central Line-Associated Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S90-S91
Author(s):  
Hesham Awadh ◽  
Melissa Khalil ◽  
Anne-Marie Chaftari ◽  
Johny Fares ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Mucosal Barrier ◽  
Causative Organism ◽  
Central Venous ◽  
Central Venous Catheter Removal ◽  
The Impact

Abstract Background There has been a rise in Enterococcus species Central Line-Associated Bloodstream Infections (CLABSI) ranking as the third overall causative organism according to the Center for Disease Control and Prevention (CDC) report issued in 2014. Central Venous Catheter (CVC) management including the need and timing of CVC removal is not well defined for enterococcus bacteremia (EB) in the 2009 Infectious Diseases Society of America (IDSA) management guidelines given the paucity of studies addressing CVC management. Methods We conducted a retrospective chart review on 543 patients diagnosed with EB between 2010 and 2018. We excluded patients without an indwelling CVC and those with mucosal barrier injury (MBI). We further evaluated 90 patients with EB that met the CDC definition for CLABSI without MBI or the IDSA definition for catheter-related bloodstream infections (CRBSI) and 90 patients with an indwelling CVC in place with documented non-CLABSI with another source. Results Early CVC removal (within 3 days of EB) was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (43% vs. 27%; P = 0.02). Microbiological eradication associated with early CVC removal within 3 days of EB was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (78% vs. 48%; P = 0.016). Complications were lower in the CLABSI without MBI/CRBSI compared with the non-CLABSI group (0% vs. 18%; P = 0.017). Defervescence, mortality (all-cause and infection-related mortality) and relapse were similar in both groups. Within each group, the outcome was similar irrespective of CVC management (removal within 3 days vs. retention). Conclusion In cases of EB, early CVC removal within 3 days of bacteremia is associated with a favorable outcome in the CLABSI without MBI/CRBSI group compared with the non-CLABSI group. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document