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[Sepsis in children with malignant neoplasia, equipped with a Broviac-type venous catheter]
A Garaventa1, E Castagnola, S Dallorso
1Divisione di Ematologia ed Oncologia Pediatrica, Istituto G. Gaslini di Genova, Italia.
Insights
Central venous catheters are vital for pediatric cancer patients but can cause infections. This study found catheter-related bacteremias occurred in 29% of sepsis episodes, particularly in non-neutropenic patients, highlighting the need for vigilant home care.
Area of Science:
- Infectious Diseases
- Pediatric Oncology
- Medical Devices
Context:
- Indwelling central venous catheters (CVCs) are essential for managing pediatric cancer patients, facilitating treatments like chemotherapy and parenteral nutrition.
- However, CVCs are a significant source of bloodstream infections, posing a risk to immunocompromised children.
- This study retrospectively analyzed CVC use and infection rates in pediatric cancer patients over an eight-year period.
Purpose:
- To assess the etiology of bacteremia in children with cancer and indwelling CVCs.
- To determine the association between bacteremia and neutropenia.
- To evaluate the relationship between CVCs and the incidence of catheter-related bacteremia (CRB).
Summary:
- A review of 584 Broviac catheters in 475 pediatric cancer patients identified 226 sepsis episodes over 108,678 catheter days.
- Catheter-related bacteremia (CRB) was diagnosed in 29% of sepsis cases (65/226), with a higher incidence in non-neutropenic (65%) versus neutropenic (35%) patients (P < 0.005).
- Gram-positive organisms were the most common CRB pathogens (43%), followed by Gram-negative rods (23%) and fungi (14%). An increasing trend of Gram-negative CRB was noted.
Impact:
- The findings underscore the importance of meticulous catheter care, especially in non-neutropenic pediatric cancer patients receiving home care.
- A high index of suspicion for Gram-negative infections is crucial in cancer patients with indwelling CVCs.
- This research informs infection control strategies and clinical management of CVC-associated infections in pediatric oncology.
Abstract:
Indwelling central venous catheters obviate many problems in the care of children with malignancies, but they also are a well-known source of infection. We are reviewed the history of 584 Broviac catheters inserted from January 1984 to December 1991, in 475 children with cancer in order to assess the etiology of bacteremias, their association with neutropenia and their relationship with the presence of the catheters. The overall duration-time of the catheters, employed for blood tests, drug and blood infusions and parenteral nutrition, was 1-835 days (median 263, mean 186). Total catheter courses was 108.678 days. In this period 226 episodes of sepsis were observed in 180 patients: 157 in neutropenic patients and 69 in non neutropenic. Catheter related bacteremias were diagnosed in 65/226 episodes (29%): 23 (35%) were observed in neutropenic patients and 42 (65%) in non neutropenic (P < 0.005). Gram-positive pathogens were isolated in 28/65 (43%) episodes, Gram-negatives in 15/65 (23%), fungi in 9/65 (14%), and the remaining 13 (20%) were polymicrobial. In the last years we observed an increase of catheter related bacteremias due to Gram-negative rods no change was observed in pathogens causing catheters unrelated bacteremias. The high incidence of catheters related bacteremias in non neutropenic, non hospitalized patients, stress on the home-care of the catheters; a high level of suspicion of Gram-negative infections should be maintained in cancer patients with an indwelling central venous catheters.