Ethanol-Lock Technique in the Treatment of Bloodstream Infections in Pediatric Oncology Patients With Broviac Catheter

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

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580. Association Between Central Venous Catheter Repair and Bloodstream Infections in a Pediatric Oncology Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.649 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S274-S274

Author(s):

Ruba Barbar ◽

Hana Hakim ◽

Patricia Flynn ◽

Aditya H Gaur ◽

Darenda Wright ◽

...

Keyword(s):

Pediatric Oncology ◽

Pediatric Population ◽

Healthcare Delivery ◽

Significant Risk ◽

Bloodstream Infections ◽

Categorical Variables ◽

Central Venous ◽

Oncology Patients ◽

Increased Risk ◽

Oncology Center

Abstract Background Central venous catheters (CVCs) are important for healthcare delivery in pediatric oncology patients. It is common to repair CVC breakage to prevent replacement. Existing evidence regarding the association between CVC repair and bloodstream infections (BSI) is limited in the general pediatric population and lacking in pediatric oncology patients. We aim at evaluating whether repairing broken CVCs is associated with an increased risk for subsequent BSI in a pediatric oncology center. Methods This is a retrospective case-crossover study of pediatric oncology patients with broken CVCs that underwent repair between July 2015 and June 2017. The incidence and characteristics of BSI in the 30-day pre-repair period were compared with those in the 30-day post-repair period. Wilcoxon-Mann–Whitney and Fisher’s Exact tests were used for comparison of continuous and categorical variables, respectively. Univariate logistic regression was used to identify potential risk factors for BSI post CVC repair. Multiple breakages of the same CVC, and BSIs in overlapping observation periods of consecutive breakages are assumed independent. Results Sixty-four patients had 99 episodes of CVC breakage/repair in 68 CVCs. Median age (range) at repair was 2.5 (0.15–17.6) years. 48% of CVC breakages occurred in patients with solid tumors, 24% in HSCT recipients, and 19% in patients with leukemia. Only 25% of patients had neutropenia at repair and 14% had CVC occlusion 72 hours prior to breakage. All CVCs were made of silicone and 88% were double lumen external tunneled. First CVC breakage occurred at a median (range) of 130 (2–718) days since insertion, and CVCs were removed at a median (range) of 72.5 (3–753) days from the last repair. End of treatment was the most common cause (43%) for removal. The post-repair incidence of BSI was 4.5 per 1000 line-days compared with a pre-repair incidence of 4.3 (RR= 0.95, 95% CI 0.44, 2.18). There is no statistical difference between the characteristics of the pre-repair and post-repair BSI (Table 1). Figure 1 shows the organisms causing BSI before and after CVC repair. None of the evaluated variables was identified as a significant risk factor for BSI 30 days after CVC repair (Table 2). Conclusion Repair of CVC in pediatric oncology patients was not associated with increased risk of BSI. Disclosures All authors: No reported disclosures.

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