Incidence of and risk factors for persistent gram-positive bacteraemia and catheter-related thrombosis in haematopoietic stem cell transplantation

Abstract

A cohort of 439 haematopoietic SCT recipients was analysed to determine the incidence of Gram-positive coccal bacteraemia and thromboembolic events associated with the use of central venous catheters (CVCs) and to determine risk factors for these complications. The incidences of persistent coagulase-negative staphylococcal (CoNS) bacteraemia, symptomatic thrombosis and thrombophlebitis were 25%, 9.6% and 6.6%, respectively. Duration of neutropenia (in days, odds ratio (OR) 1.02; P ¼ 0.04) and leftsided placement of the CVCs (OR 1.73; P ¼ 0.03) were independent risk factors for the occurrence of persistent CoNS bacteraemia, whereas the use of less mucotoxic conditioning regimens was associated with a lower risk (high-dose melphalan (HDM)/BEAM vs other regimens, OR 0.24; Po0.001). Use of TBI, persistent CoNS bacteraemia and tip colonisation were all significantly associated with an increased risk of symptomatic thrombosis (OR 6.03, 3.36 and 2.80, respectively; Pp0.02). The risk factors found in this cohort of SCT recipients differed from those found in the general cancer population, showing an important role for persisting bacteraemia in the pathogenesis of CVC-associated thrombosis. Therefore, we constructed a new algorithm in order to improve catheter management and prevent these CVC-related complications.

Risk factors for pre‐ and post‐engraftment bloodstream infections after allogeneic hematopoietic stem cell transplantation

“…(46.9%) . CoNS originate from the resident commensal flora of the skin and gut, and are present through either an exogenous route (for instance, migration from the skin along the catheter tract or via a catheter hub) or an endogenous route, as a result of hematogenous seeding from a distant infection site or disrupted mucosal barriers of the oral cavity and gastrointestinal tract . In other studies, Enterococcus species and Streptococcus species were also commonly isolated GPB .…”

Central venous catheter-related thrombosis in senile male patients: New risk factors and predictors

“…Approximately 1.5% to 66% of clinical cases of CVC-related venous thrombosis are asymptomatic [11][12][13][14][15] , and the incidence rate of symptomatic CVC-related venous thrombosis in patients with hematopoietic stem cell transplantation can decrease to 9.6% [16] . The clinical conditions of senile patients are more complicated than those of middle-aged or young patients because of age-related physical degeneration and multiple basic diseases.…”

Update on infection control practices in cancer hospitals

“…In recent studies, the reported catheter‐related infection rate in adults with cancers was from 0.02 to 3 per 1000 catheter‐days, and the incidence of exit‐site infection ranged from 1.9% to 60.9% . Risk factors reported for CLABSI in patients with cancer include thrombosis, difficulty during the insertion procedure, total parenteral nutrition, neutropenia, age, hematologic malignancies, and HCT …”