scholarly journals Effect of Early Removal of Central Catheterization in Febrile Neutropenic Patients with Acute Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4895-4895
Author(s):  
Su Hyun Hwang ◽  
Yong Won Choi ◽  
Seong Hyun Jeong ◽  
Joon Seong Park
Keyword(s):  
Febrile Neutropenia ◽  
Acute Leukemia ◽  
Conflicts Of Interest ◽  
Blood Stream Infection ◽  
Univariate Analysis ◽  
Blood Stream ◽  
Central Line ◽  
Central Catheter ◽  
Early Removal ◽  
Neutropenic Patients

Abstract Background: A guideline of central line-related blood stream infection (CRBSI) is only for immune-competent patients with end-stage renal disease on hemodialysis. We need widely acceptable guideline whether remove or maintain a central catheter in febrile neutropenic patients. Method: Medical records from 293 cases (95 patients) of febrile neutropenia with Central Catheterization were obtained retrospectively, and clinical characteristics, particularly duration of fever, were analyzed according to the early removal of central catheterization under anti-cancer chemotherapy for acute leukemia. Results: Forty-eight cases (16.4%) have already baseline fever and 25 cases (8.5%) showed baseline pneumonic infiltration prior to chemotherapy. The insertion sites of catheterization were subclavian (85.3%), internal jugular (12.6%), and others (2.0%). Early removal of central catheter was done at 93 cases (31.7%) and the cause of early removal was fever (63.4%), malfunction (11.8%), and others (24.7%). The duration of fever was significantly shortened by early removal of central catheterization (5.4 vs 7.5 days, p=0.003, Figure 1A). In addition, the duration of fever was related with age, diagnosis, type of chemotherapy, presence of baseline fever or pneumonic consolidation in univariate analysis. The site of central access or body mass index as well as existence of CRBSI did not affect duration of fever. In multivariate analysis, early removal of central catheter was independently associated with short duration of fever (OR=0.619, 95% CI=0.46-0.83, p=0.001, Table 1). The effect of early removal of central catheter was highlighted when micro-organisms were documented (Figure 1B). Summary: In patients with febrile neutropenia, early removal of central catheter can shorten the duration of fever particularly when BSI was documented. Disclosures No relevant conflicts of interest to declare.

scholarly journals Can Early Removal of Central Venous Catheter Influence Duration of Fever in Febrile Neutropenic Patients with Acute Myeloid Leukemia?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1615-1615
Author(s):  
Tae Hwan Kim ◽  
Yong Won Choi ◽  
Seong Hyun Jeong ◽  
Joon Seong Park
Keyword(s):  
Acute Myeloid Leukemia ◽  
Multivariate Analysis ◽  
Febrile Neutropenia ◽  
Blood Sample ◽  
Myeloid Leukemia ◽  
Univariate Analysis ◽  
Blood Stream ◽  
Central Catheter ◽  
Early Removal ◽  
Acute Myeloid

Abstract Background: Febrile neutropenia is considered a medical emergency and generally prompts immediate hospitalization. For this reason, many physicians and researchers have tried some attempts to reduce the duration of febrile neutropenia. Patients with hematologic disorders frequently require the insertion of medium or long-term central venous catheters (CVCs) for stem-cell transplantation, the administration of chemotherapy, or transfusion of blood products. We have already known that the CVC is a major source of bloodstream infections in the neutropenic patients, but, there have been no reports about the duration of febrile neutropenia in the cases with early removal of CVCs except for catheter-related blood stream infections (CRBSIs). In this study, we want to investigate the factors influencing the duration of febrile neutropenia including early removal of CVCs except for CRBSIs in the patients diagnosed with acute myeloid leukemia. Methods: A total of 161 central catheter insertion cases with febrile neutropenia except for CRBSIs in 102 patients were eligible for analysis. CRBSI was defined as the same microorganism grown from at least one percutaneous blood culture and from a culture of the catheter tip (>15 colony-forming units), or a growth of microbes from blood sample drawn from a catheter hub at least 2 hours before microbial growth was detected in a blood sample obtained from a peripheral vein. Patients with blood stream infection (BSI) were defined as those with clinical signs of infection and the microorganism grown from at least one percutaneous blood culture without detecting microorganism from a culture of the catheter tip or from blood sample drawn from a catheter hub. The early removal of CVCs was defined as the removal of CVCs before 21 days from the insertion date of CVC. Duration of fever was investigated according to age, gender, body mass index (BMI), type of chemotherapy, presence of baseline fever, presence of BSI and/or early removal of central catheter by the Kaplan-Meier method and the Log Rank method. Statistical analysis was performed using SPSS software version 13.0 (IBM, Armonk, NY, USA). Results: Baseline characteristics of total cases were described in Table 1. Univariate and multivariate analysis about duration of fever are summarized in Table 2 and Table 3. Age, type of chemotherapy, presence of baseline fever and early removal of central catheter were significant in the univariate analysis and age, type of chemotherapy and early removal of central catheter were also significant, but, baseline fever was not significant in the multivariate analysis. Furthermore, duration of fever in the remission induction chemotherapy was significantly longer than consolidation chemotherapy, on the other hand, not significantly longer than salvage chemotherapy. Conclusion : In this retrospective study, age, type of chemotherapy, presence of baseline fever and early removal of central catheter were significant in the univariate analysis. They were equally significant in the multivariate analysis, only except for the presence of baseline fever. It is noteworthy that the cases with early removal of CVCs except for CRBSIs had significant reduction of the duration of febrile neutropenia. We may need active consideration about the early removal of CVCs in the acute myeloid leukemia patients with febrile neutropenia for the purpose of reduction of the duration of febrile neutropenia. Disclosures No relevant conflicts of interest to declare.

Evaluation of the Association of Bacteraemia with the Severity of Neutropenia

2017 ◽  
Vol 1 (01) ◽  
pp. 13-15
Author(s):  
Md. Kamrul Hasan ◽  
Amin Lutful Kabir ◽  
Adnan Hasan Masud ◽  
Md. Mahbubur Rahman
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Blood Stream Infection ◽  
Prophylactic Antibiotic ◽  
Blood Stream ◽  
Febrile Episode ◽  
Severe Neutropenia ◽  
Management Algorithm ◽  
Blood Culture Positivity ◽  
Neutropenic Patients

Background: Blood culture is a part of management algorithm in febrile neutropenia. However, the incidence of positive result of blood culture is decreasing and the spectrum of the causative microbial is changing over time. Objective: The objective of this study was to see the incidence of bacteraemia and its association with the severity of neutropenia. Methodology: Based on naturally occurring blood stream infection, we evaluated 47 febrile neutropenic patients using blood culture to see the incidence of bacteraemia during the period between October 2009 and October 2010. Results: The overall rate of blood culture positivity was 17% (8/47). It was found to be significantly higher in 32% (8/25) (p = 0.014) of patients with very severe neutropenia, 26.9% (7/26) (p = 0.044) positivity was found when blood culture was done on the first day of febrile episode and 41.7% (5/12) (P = 0.008) in the absence of prophylactic antibiotic. Conclusion: Blood culture was found to be a valuable tool for the evaluation of bacteraemia and should be used in all cases of febrile neutropenia.

scholarly journals Is it safe to remove central lines in patients with platelets less than 20,000/uL

2021 ◽  
Author(s):  
Priya Marwah ◽  
Stalin Ramprakash ◽  
Sai Prasad T R ◽  
Mane Gizhlaryan ◽  
Deepa Trivedi ◽  
...  
Keyword(s):  
Platelet Transfusion ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Severe Thrombocytopenia ◽  
Blood Stream Infections ◽  
Central Lines ◽  
Neutropenic Patients ◽  
Bleeding Episodes ◽  
Clinical Risks

Background: Patients with tunnelled CVL may develop blood stream infections which at times are difficult to control without line removal. Concomitant severe thrombocytopenia with platelet transfusion refractoriness is often considered a hard contraindication to any procedure involving a major blood vessel. There is very little literature on the actual clinical risks of tunnelled central line removal in febrile pancytopenic patients. Procedure: We analysed complications and outcomes in all or patients, a total of 52, who underwent CVL removal with platelets <20,000/uL. Results: No bleeding episodes or unplanned transfusions could be associated with CVL removal. No other complications were also reported. All patients had time to hemostasis within 5 minutes of catheter removal. A total 31 patients were febrile at the time of CVL removal, of which 17 became afebrile within 2 days. We found no difference in response when comparing those whose antibiotic therapy was change/escalation versus those who did not. Removal of CVL under local anaesthesia remained complication-free even at platelets counts less than 20.000/uL. With only RDP support 17 lines were pulled out without any complications when platelets were below 5.000. Conclusion: Our findings suggest that central lines can be safely removed with platelet counts less than 20.000/ul and that this may result in enhanced blood stream infection control. This might be particularly relevant to neutropenic patients in this day and age of MDR germs emergence and paucity of new effective antibiotics.

scholarly journals Is it cost effective to use a 2% chlorhexidine wipes bath to reduce central-line associated blood stream infection? A quasi-experimental study

2021 ◽  
Vol 25 (1) ◽  
pp. 101538
Author(s):  
Diego Feriani ◽  
Ercilia Evangelista Souza ◽  
Larissa Gordilho Mutti Carvalho ◽  
Aline Santos Ibanes ◽  
Eliana Vasconcelos ◽  
...  
Keyword(s):  
Experimental Study ◽  
Blood Stream Infection ◽  
Cost Effective ◽  
Blood Stream ◽  
Central Line ◽  
Quasi Experimental

scholarly journals Central Line-Associated Blood Stream Infection During COVID-19 Pandemic

2021 ◽  
Author(s):  
Fatima Aldawood ◽  
Aiman El-Saed ◽  
Mohammed Al Zunitan ◽  
Majed Alshamrani
Keyword(s):  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line

scholarly journals Evaluation of Specific Risk Factors and Outcomes of Colistin-Resistant Klebsiella pneumoniae Infections in a Tertiary Care Centre - An Observational Study

2021 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Prakash Shastri ◽  
Shamanth A Shankarnarayan
Keyword(s):  
Risk Factors ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Multidrug Resistant ◽  
Automated System ◽  
Tertiary Care Centre ◽  
Broth Microdilution Method

Background: Incidence of multidrug resistant Klebsiella pnumoniae infections are increasing globally especially in ICUs. Aim: We evaluated the burden of colistin resistant K. pneumoniae (ColR KP) and the risk factors associated with the outcome of these patients. Methods: Consecutive patients developing K. pneumoniae infections were included. K. pneumoniae from endotracheal tube and catheterized urine sample, having cell count <105 cfu/ml, and which did not necessitate a change in antibiotics as per the treating physicians was considered as colonizer. Demographic and clinical details were collected and samples were processed as per standard protocol. Any growth was identified and its antimicrobial susceptibility was carried out by using Vitek 2 automated system. Minimum inhibitory concentration of >4 μg/ml for Colistin was considered as resistant. The resistant isolates were confirmed with Broth microdilution method. Risk factor associated with the outcome of ColR KP was analyzed. Findings: Burden of K. pneumoniae infection was 50.02 per 1000 admissions. K. pneumonie (n=155) was isolated from patients with ventilator associated pneumonia (84, 54.2%), followed by blood stream infection (49, 31.6%) and urinary tract infection (22, 14.2%). ColR KP and intermediate (ColI KP) isolates were 58 (37.41%) and 97 (62.6%) respectively. Among ColR KP infected patients 32 (55.1%) died whereas 26 (44.8%) patients were discharged. Higher mortality was witnessed in ColI KP cases (75, 77.3%) compared to ColR-KP cases (32, 55.1%) (p=0.004; OR=2.77; 95% CI=1.37 to 5.59). Colistin resistance and presence of central line were independently associated with mortality. Conclusion: Colistin resistant K. pneumoniae infections among ICU patients are on rise. Presence of central venous catheter and resistance to colistin were independent predictors of mortality.

Sign in / Sign up

Export Citation Format

Share Document