Nosocomial Colonization, Septicemia, and Ilickman/Broviac Catheter-Related Infections in Bone Marrow Transplant Recipients: A 5-Year Prospective Study

Abstract

In this 5-year prospective study of 242 bone marrow transplantation (BMT) recipients from whom daily blood cultures via the indwelling Broviac/Hickman catheter were obtained, there was a median of 35 catheter-days during hospitalization, mean of 40 days, and total of 9,667 catheter-days which were divided almost equally between neutropenic (4,771) and non-neutropenic (4,896) days. One hundred twenty (50%) patients had a total of 161 episodes of nosocomial bacterial or candidal infections. Overall, 81 (33%) patients experienced 100 episodes of catheter-related infections and 90 (37%) patients experienced 112 episodes of septicemia, including 51 episodes of catheter-related septicemia. There was an incidence of 11.59 septicemia episodes, including 5.28 catheter-related septicemia episodes, 2.48 colonization only (without subsequent septicemia), and 2.59 exit site infections only, per 1,000 catheter-days. Over a period of a total of 6,593 afebrile days, 34 (14%) patients developed 40 episodes of colonization, a rate of 6.07 per 1,000 afebrile days, of which 16 developed into septicemia. Twenty-five patients had 1 episode each of exit site infection without bacteremia. There were 10 (4%) septicemia-related deaths, 4 of which were catheter-related; 50% of all deaths involved Pseudomonas aeruginosa. The mortality due to catheter-related septicemic episodes was not greater than that of the non-catheter-related episodes. Neutropenia was found to be a significant risk factor in our study: 76% of the septicemia episodes (85/112) and 65% of the catheter-related infectious episodes (65/100) occurred during neutropenia. There was a higher incidence of septicemic episodes during neutropenia than during non-neutropenic periods, 17.82 versus 5.51 per 1,000 days (p < 0.0001), and a higher rate of catheter-related infections during the neutropenic period, 13.62 versus 7.15 during non-neutropenic days per 1,000 days (0.001). Fourteen of 16 colonization episodes developed into septicemia during neutropenia versus 2/24 during non-neutropenic periods, a rate of 5.47 versus 0.47 per 1,000 afebrile days, respectively (p < 0.0001), and 9/10 deaths occurred during neutropenia.

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

“…However, it is important to note that BSI occurring late in the posttransplant course is not unusual, as demonstrated in this and other studies. 1,10,[12][13][14] The independent risk factors for BSI of reduced intensity allogeneic HSCT and the degree of donor-recipient HLA mismatch determined in our study is not surprising. Possible explanations for this are the selection of more debilitated patients (and therefore at higher risk for BSI) for reduced intensity HSCT protocols and increased potential for the development of GVHD and the need for immunosuppressive medications if there is HLA mismatch between the donor and recipient.…”

“…BSI usually occurs during the preengraftment phase but can occur more than 100 days after HSCT. 1,[10][11][12][13][14] Several risk factors for BSI after HSCT have been described. These include age greater than 18 years, underlying disease, late stage of underlying disease, the presence of a Hickman catheter infection, severe graft-versus-host disease (GVHD), mucositis and steroid use.…”

Infections among allogeneic bone marrow transplant recipients in India

“…Catheter-related infections are less common (7.8%) compared with the available data where the incidence varies from 12 to 40%. 26 This may be related to the aggressive catheter care practised by our nursing staff for all transplant recipients.…”

Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation

“…19 Enterococci readily acquire antibiotic resistant genes and elaborate substances which promote adherence to host tissues, induce tissue damage, and produce inflammatory reactions. 10 Risk factors predicting the acquisition of VRE include the presence of a central venous catheter, neutropenia, 20 intestinal colonization, 5,17 recent or current administration of vancomycin, third generation cephalosporins, metronidazole, clindamycin or imipenem, 5,17,21 severity of underlying disease, 5 7 or more days of hospitalization especially in a surgical ICU, 21 more than 7 days of vancomycin use, 21 and transfer between floors. 21 Most of the patients in the current study were neutropenic and all were severely immuno-compromised.…”