Efficiency of antimicrobial surface treated central venous catheters in the prophylaxis of catheter-associated infections in children with oncohematological diseases
Yulia Simakina, Olga Ivanova, Elisa Kubieva, Elena V. Morozova, Ekaterina Goncharova, Ludmila S. Zubarovskaya, Boris V. Afanasyev
Raisa Gorbacheva Memorial Institute of Children Oncology Hematology and Transplantation, First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia
Bloodstream infections are among the most common nosocomial infections worldwide. Up to one-third of all primary bloodstream infections are associated with central venous catheters (CVC), as well as various general and local infectious complications. There are different pathogenetic mechanisms of the Central Line-Associated BloodStream Infections (CLABSI). The insertion site contamination, pathogen migration along external surface, intraluminal colonization of the catheter hub, and hematogenous spread are among the main reasons for these conditions. Risk factors of infectious complications include emergent catheterization, active infection process, bacteremia, disease state, comorbidities, duration of catheterization and professional skills of surgeons and nurses. The goal of this study was to evaluate characteristics of central vein cathetherization in children with oncohematological diseases (3 to 15 years old), searching for ways to minimize the CLABSI risks.
Patients and methods
A group of 59 patients with oncohematological diseases was enrolled into the study. In most cases, CVC was installed upon admission to the hospital. All the patients received CVC via subclavian approach. There were no early complications associated with CVC insertion. There were different indications for catheterization, i.e., hematopoietic stem cell transplantation (HSCT) in 33 patients, polychemotherapy (PCT), in 19 cases, and extracorporeal photopheresis in 7 patients. Antimicrobial surface-treated CVCs Certofix® Protect (B. Braun) were used in 30 patients. A control group included 29 patients with non-antimicrobial surface treated polyurethane CVC Certofix®.- B. Braun. The tasks of our study were as follows: evaluation of dwelling time for the CVC and efficiency assessment of the antimicrobial Certofix® Protect CVCs for the CLABSI prophylaxis in oncohematological patients treated by polychemocherapy (PCT) or stem cell transplantation (SCT) with high risk for infectious complications. Febrile temperature without local infection and/or positive hemoculture in peripheral blood were attributed to CLABSI. Comparison of CVC blood culture with peripheral blood culture or CVC tip culture were used to confirm the diagnosis. Visual observation of the CVC insertion site was performed on daily basis.
It was demonstrated that the number of catheter lumens was not directly associated with the incidence of CLABSI. Average dwelling time of antimicrobial surface treated CVC Certofix® Protect was 21 days (ranging from 2 to 48), and in control group, 18 days (ranging from 1 to 39). CLABSI was indication for cathether removal in 1 patient (3,3%) in the studied group, and in 5 patients (17,2%) in control group. Microbiological confirmation of CVC contamination was noted in 1 case (3,3%) in first group and in 4 cases (13,8%) in controls. Microbiological cultures demonstrated a broad spectrum of CLABSI. The most common infectious agents were St.aureus, Enterococcus spp., St. epidermidis, Kl.pneumoniae. Less common microorganisms were Acinetobacter spp., Enterobacter spp., Pseudomonas aeruginosae, Candida spp.
Antimicrobial surface-treated Certofix® Protect – B. Braun CVCs in patients with oncohematological diseases represents a rational option for applications in the PCT and HSCT patients, being associated with a statistically significant decrease of CLABSI rates. Disclaimer. This is not an advertisement of the В.Braun catheters. However, overview of publications in the area allows us to choose this type of CVC as the most effective one in the prophylaxis of infectious complications.
Chemotherapy, blood malignancies, bacteriaemia, central vein catheters, antimicrobial surface-coated, efficiency