Hickman-Broviac catheter-related infections in children with malignancies

Infectious complications are frequently encountered following Hickman-Broviac (H-B) catheter insertion. The medical records of 164 children with malignancies who underwent H-B catheter insertion from March 1, 1988 to December 31, 1997 were reviewed retrospectively. During a 35,697 catheter-day period, 77 catheter-related infections occurred, including 50 catheter-insertion-site infections and 27 bloodstream infections. The risk for the development of catheter-related infections was 2.15 per 1000 catheter-days (1.4 and 0.75 per 1000 catheter-days for catheter-insertion-site and bloodstream infections, respectively). In 17 (63%) of 27 episodes of bloodstream infections, antimicrobial treatment controlled the infection without catheter removal. A previous catheter-insertion-site infection caused by Staphylococcus epidermidis (p=0.01), the occurrence of mechanical catheter complications (p=0.007), and a normal coagulation status of the host (p=0.03) were significantly associated with the development of catheter-related bloodstream infections. H-B catheters remain important in pediatric oncology. Due to the significant morbidity associated with the development of catheter-related bloodstream infections, risk factors found to increase the incidence rate of such infections must be identified and properly managed.