Prevention of indwelling central venous catheter sepsis

Abstract

In an attempt to decrease the incidence of central venous catheter sepsis in children with cancer, we conducted a study to evaluate the benefit of adding broad-spectrum antibiotics to the catheter "flush solution." In a prospective, placebo-controlled, double-blinded, randomized trial, 69 children with different types of malignancies were studied. The central venous catheters in these children were flushed with either the standard solution (normal saline + 100 U/ml of heparin) or the study solution (25 @nl of both arnikacin and vancomycin added to the standard solution). At the conclusion of the study, 64 children with a total of 67 indwelling central venous lines were assessable. The total catheter days on study were 20,700 days, with a median of 323 catheter days per patient. We documented 10 events of catheter-related infections (0.49 eventdl ,000 catheter days at risk). Five of these events were catheter-related sepsis (0.24 sepses/l ,000 catheter days): two were fungal and three were bacterial. Due to the low incidence of catheter-related sepsis in this study, no statement regarding the prophylactic use of antibiotics could be made. The extremely low rate of catheter-related sepsis reported herein may be retrospectively attributed to continuous staff education regarding aseptic techniques in handling these catheters. Staff education is essential, and probably the most effective factor in preventing catheterrelated sepsis. o 19% ~i~e y -~i s s , Inc.

Bloodstream infections can develop late (after day 100) and/or in the absence of neutropenia in children receiving allogeneic bone marrow transplantation

“…However, CVC-related episodes accounted for 40% of episodes in patients receiving allogeneic BMT, but only 8% in patients receiving autologous BMT (P Ͻ 0.001). This particular aspect could be due to the fact that patients undergoing allogeneic BMT use CVC, for a longer period because of the complexity of their management in the post-transplant period (eg for control of GVHD or CMV infection) and are therefore exposed to major risk because of the frequent necessity for venous access, [10][11][12][13] perhaps by parents at home. 13,14 However, we have no data to support this supposition.…”

Guidelines for the Prevention of Intravascular Catheter–Related Infections

“…Use prophylactic antimicrobial lock solution in patients with long term catheters who have a history of multiple CRBSI despite optimal maximal adherence to aseptic technique [120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136][137][138]. Category II…”

Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

“…72,[83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99] The remaining six studies included citrate or taurolidine. [100][101][102][103][104][105]123 Most studies were conducted in patients undergoing haemodialysis (n = 17), but there were four studies in children with cancer.…”

“…Fourteen studies followed up patients for ≥ 3 months, three of these followed patients for > 10 months (see Table 14). 83,93,96 Very large studies with long-term follow-up would be required to provide clear evidence to support or refute widespread concerns about rare but serious infections with resistant organisms due to the use of antimicrobial locks. However, other studies have reported selection of antibiotic-resistant strains.…”