Central venous catheters (CVCs) represent a significant source of infection in patients undergoing hematopoietic stem cell transplantation and can add to the cost of care, morbidity, and mortality. Organisms forming biofilms on the inner surface of catheters require a much higher local antibiotic concentration to clear the pathogen growth. Antibiotic lock therapy (ALT) represents one such strategy to achieve such high intraluminal concentrations of antibiotics and can facilitate catheter salvage. Patients with catheter colonization (CC) or hemodynamically stable catheter‐related bloodstream infection (CRBSI) received ALT per institutional policy. We analyzed the incidence of CC and CRBSI and salvage rate of tunneled CVCs (Hickman) with ALT in patients undergoing hematopoietic stem cell transplant in this retrospective study. Catheter colonization was noted in 9.8% and CRBSI in 10.7% patients. Gram‐negative bacilli (GNB) accounted for 45% and 83% of isolates in CC and CRBSI, respectively. In patients with CRBSI, the rate of catheter salvage with the use of ALT in addition to systemic antibiotics was 86% compared to 55% in patients with systemic antibiotics use only (P = 0.06). There was no CRBSI related mortality, and no increase in resistant strains was noted at subsequent CRBSI. In conclusion, ALT represents an important strategy for catheter salvage, especially for gram‐negative infections, in a carefully selected patient population.

Thyroid gland and thyroid cartilage infiltration in multiple myeloma (MM) are rare. Here, we discuss a patient who presented with hoarseness of voice and was found to have a hypodense lesion in right lobe of thyroid involving thyroid and cricoid cartilage. Fine-needle aspiration cytology with immunohistochemistry revealed extramedullary plasmacytoma of thyroid. MM was ruled out initially by serum protein electrophoresis, immunofixation, and bone marrow biopsy. Later, lytic lesions were found in multiple bones on radiation planning scan and he was finally diagnosed as case of MM with thyroid involvement. Treatment strategies of MM and thyroid plasmacytoma are also discussed briefly.

Inflammatory myofibroblastic tumor (IMFT) or pseudotumor is a rare tumor that can be seen in various organs. It is an enigmatic tumor of unknown etiology and difficult to differentiate from malignancy, clinically as well as radiologically. Histologically, it is composed of variable proportions of proliferating spindle myofibroblasts, fibroblasts, extracellular collagen, lymphocytes and plasma cells. This mainly affects the urinary bladder or prostate. Renal involvement is extremely rare and may pose diagnostic difficulty to the clinician. We describe a renal IMFT, mimicking renal malignancy, having unusual histological features.

Background: Catheter Related Blood Stream Infection (CRBSI ) and catheter colonization (CC) represent a significant problem encountered in hematopoietic stem cell transplantation (HSCT) setting adding to the morbidity, mortality and cost of healthcare in such patients. Unlike non-tunneled central venous catheters (CVCs), the higher complication rates and added cost associated with reinsertion of a tunneled CVC makes it important to devise effective strategies for catheter salvage.We report the incidence of CRBSI and CC of tunneled CVCs in our patients and use of antibiotic locks to salvage these catheters. Materials and Methods: All patients who underwent HSCT between September 2008 and December 2013 in our centre were included in this study. These patients underwent tunneled CVC (Hickman) insertion through internal jugular vein by Seldinger technique. Wherever possible, triple lumen Hickman catheters were used for patients undergoing allogeneic transplant, whereas double lumen catheters were used for those undergoing autologous transplant. Post insertion, surveillance blood cultures from all lumina of the catheter were taken. Catheter colonization (CC) was defined as growth of an organism from any lumen of the catheter without any evidence of fever as part of surveillance strategy. CRBSI was defined as growth of a recognized pathogen from catheter without growth from peripheral vein or growth from catheter with similar growth from peripheral vein with 2 hours lesser incubation for catheter in the presence of fever (>38o C), chills or hypotension. Antibiotic lock was used in all patients with CC according to the suceptibility patterns of the isolates, which included a third generation cephalosporin- β-lactamase inhibitor combination, aminoglycoside or carbapenem for gram negative bacteria; vancomycin, teicoplanin or linezolid for gram positive organism and amphotericin B or voriconazole for candida species. These patients did not receive systemic antibiotics. Systemic antibiotics were used in all cases of CRBSI. Catheters were removed in cases with persistent fever ( >72h), hemodynamic instability and repeated culture positivity. Antibiotic lock was continued for a total of 14 days with repeat cultures taken on 4th, 5th, 6th, 7th and 14th day of lock. Results: Two hundred and twenty four patients (95 allogeneic and 129 autologous) underwent HSCT. The incidence of CC was 9.8 % (22/224) while CRBSI was seen in 10.7 % (24/224). Coagulase Negative Staphylococcus (CONS) and gram negative organisms (Pseudomonas aeruginosa-3, E.Coli-2, Acinetobacter baumanni-2, Klebsiella pneumonia-2 and Sphingobacterium thalpophilum-1) were seen in 10 each (45%) of CC. One case of Candida tropicalis causing CC was noted. Antibiotic lock was used in 21 of 22 CC cases. Catheter salvage was successful in 95% (20 / 21) cases. One case of CC progressed to CRBSI and required systemic antibiotics. Amongst CRBSI, gram negative bacteria accounted for 83% (20 / 24) of the cases ( Pseudomonas aeruginosa-6, Acinetobacter baumanni-4, E coli-4, Klebsiella pneumonia-3, Ralstonia picketti-3, Stenothrophomonas maltilophila-2, Sphingomonas paucimobilis-1 and Ochrobactrum anthropi-1). Forty-five percent of E. coli & Klebsiella pneumonia confirmed to be Extended Spectrum β-Lactamase (ESBL) producers. Vancomycin resistant enterococci (VRE) and Candida parapsilosis related CRBSI were seen in 1 patient each. Antibiotic lock was used for 15 of the 24 cases of CRBSI. Catheter salvage was successful in 86% (13 / 15) patients. Two patients had a second episode of CRBSI, after an interval of 50 and 10 days respectively from last documented negative culture. The organisms in both these cases were gram negative bacteria. Conclusion: More than 80% of patients with catheter colonization and CRBSI could be salvaged with appropriate antibiotic locks in our setting. The use of antibiotic lock for tunneled CVCs is an effective strategy for catheter salvage in HSCT patients with CC and CRBSI. Disclosures No relevant conflicts of interest to declare.

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