Cure of Implantable Venous Port–Associated Bloodstream Infections in Pediatric Hematology‐Oncology Patients without Catheter Removal

Abstract

The efficacy of antibiotic treatment of port-associated bloodstream infection without device removal has not been systematically studied. We analyzed the outcome of 43 consecutive portassociated bloodstream infections in pediatric hematology-oncology patients. Etiologies included Staphylococcus epidermidis (30) and Staphylococcus aureus (6). Antibiotics were given through the port for a median of 11 days. Four ports were removed within 72 hours. In 36 (92%) of the remaining 39 episodes, there was a response to antibiotic therapy (defervescence and negative blood culture). In 78% of episodes in which there was a response (excluding two in which the catheters were removed because of mechanical problems), the infections were cured without port removal. Two of the four relapses were cured with a second course of antibiotics. The cure rate was 92% for S. epidermidis infections and 67% for S. aureus infections. Thus, the majority of port-associated bloodstream infections in pediatric hematology-oncology patients can be cured without device removal.There are two types of surgically placed, subcutaneously tunneled Silastic (Dow Corning, Midland, MI) central venous catheters designed for long-term use. Broviac-or Hickmantype catheters exit through the skin after being passed through a subcutaneous tunnel, and totally implantable venous access ports ("ports") end in a subcutaneous reservoir after being passed through a subcutaneous tunnel (as, for example, with Mediport [Norfolk, Medina, NY] and Port-A-Cath [Pharmacia Deltec, St. Paul] ports). Ports are accessed by means of a special needle through intact skin. In pediatric oncology patients, ports are associated with a lower rate of catheterrelated bloodstream infection than are Broviac/Hickman catheters [1][2][3][4].Although cure of bloodstream infections related to nontunneled vascular catheters generally requires catheter removal, we and others have found that ϳ75% of Broviac/Hickman catheter-related bloodstream infections are cured without catheter removal [3][4][5][6]. In contrast, there are limited data concerning the efficacy of antibiotic treatment of port-associated bloodstream infection without port removal. To determine the advisability of initial antibiotic therapy without device removal, we studied the outcome of consecutive catheter-related bloodstream infections occurring in pediatric hematologyoncology patients with totally implantable venous access ports. MethodsPatient population. All pediatric hematology-oncology patients cared for at the Schneider Children's Hospital (New Hyde Park, NY) between 1 January 1991 and 31 December 1993 were identified through a log book of all patients seen by the division of pediatric hematology/oncology. Patients with a port were identified by review of the comprehensive flow sheets maintained for each patient by that division, on which data on all surgically placed vascular catheters, hospital admissions, infections, courses of antibiotic therapy, and vascular catheter removal are tabulated prospectively.To ensure that a...

Infectious complications of implantable ports and Hickman catheters in paediatric haematology–oncology patients

“…As reported previously, 12,20,22,25,26 coagulase-negative staphylococcus was the dominant organism in implantable ports. It is possible that skin flora grow down the outside of the needle, leading to colonization and infection.…”

Validity of Earlier Positivity of Central Venous Blood Cultures in Comparison with Peripheral Blood Cultures for Diagnosing Catheter-Related Bacteremia in Cancer Patients

“…CRB is known to be frequently caused by CNS, a microorganism known for its low pathogenicity and its high probability of cure without IVD removal (3) but is less often described when caused by pathogenic microorganisms (26). Therefore, it seems extremely difficult to draw any conclusions about episodes affecting patients with neutropenia and/or another infection.…”

“…Several cancer centers have shown that CRB occurs in 10 to 20% of hospitalized patients with cancer (13,16,17). In cancer patients, it is preferable not to remove the IVD if the microorganism species allows it to be left in place, and several authors showed the efficacy of antibiotic treatment of portassociated bacteremia without IVD removal (26).…”

Catheter-related infections in children treated with hemodialysis

“…The results of a number of studies of children have suggested that some catheter-related infections may be cleared by antimicrobial therapy alone, and that the CVC need not be removed in up to 75% of cases [67,68,69,70,71,72,73]. Furthermore, although there have been anecdotal reports of the cure of fungemia without catheter removal, the treatment of CVC-associated fungemia while retaining the catheter has a low success rate and may be associated with a higher mortality [8].…”