Central venous catheter–related bloodstream infections in patients with hematological malignancies: Comparison of data from a clinical registry and a randomized controlled trial

Schalk, Enrico; Teschner, Daniel; Hentrich, Marcus; Böll, Boris; Panse, Jens; Schmidt‐Hieber, Martin; Vehreschild, Maria J. G. T.; Biehl, Lena M

doi:10.1017/ice.2019.335

Cited by 8 publications

(9 citation statements)

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“…15 The rates of CRBSI/CLABSI of this cohort are in line with previous data from surveillance-and prospective studies on CVC complications in patients with hematologic malignancies. 1,[16][17][18] Consistent with our data, Dix and colleagues 17 reported in a heterogenous cohort of patients with hematologic malignancies a significantly higher rate of CRBSI in patients with IJV-, compared to SCV-CVC. The authors discussed facial hair growth and movement of the neck as a cause for dressing disruption, subsequent CVC colonization and CRBSI.…”

Section: Discussionsupporting

confidence: 90%

The insertion site is the main risk factor for central venous catheter‐related complications in patients with hematologic malignancies

et al. 2022

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Central venous catheters (CVC) placed either via the internal jugular vein (IJV) or the subclavian vein (SCV) are routinely used in patients with hematologic malignancies.In this retrospective study, we systematically compared CVC-associated complications for both insertion sites, IJV and SCV. Between January 2011 and June 2013, all consecutive patients (n = 87) were included with at least one CVC (n = 153; n = 94 IJV; n = 59 SCV) at our institution due to induction/consolidation for AML/ALL or autologous hematopoietic cell transplantation (HCT). Primary study endpoints were central line-associated (CLABSI), catheter-related (CRBSI) blood stream infections and local inflammation (LI) at the insertion site. CRBSI occurred earlier and more frequently in the IJV-versus the SCV-group with an incidence rate of CRBSI at day 15 of 10% versus 0% (p = .04) and a rate of CRBSI per 1000 CVC days of 5.7 versus 1.2. In addition, CLABSI was detected more often in IJV-compared to SCV-CVC (26% vs. 8%, p = .009). Conversely, LI occurred more frequently and earlier in SCV-versus IJV-CVC (88% vs. 56%, p < .0001) with a median time to LI of 9 versus 14 days (p < .0001). The strongest risk factor for the endpoints CRBSI, CLABSI, and LI was the insertion site. However, SCV insertion was a risk factor for LI (p = .001, HR: 2.0), insertion in the IJV a risk factor for CLABSI (p = .044, HR: 2.7) and CRBSI (p = .036, HR: 5.4). These results demonstrate a differential effect of the insertion site of CVC in neutropenic patients with a significantly reduced frequency of CVC-related blood stream infections in SCV-CVC. | INTRODUCTIONPatients with hematologic malignancies frequently require nontunneled central venous catheters (CVC) for the administration of chemotherapy, fluid infusions, blood transfusions, antimicrobial therapy, parenteral nutrition, and blood sampling over several weeks. However, CVC carry a major risk of catheter-related infections, leading to prolonged hospitalization and increased morbidity and mortality. [1][2][3] Particularly in the neutropenic phase, the risk for local infection at the insertion site and central line-associated blood stream infections (CLABSI) and catheter-related blood stream infections (CRBSI) is high. 2,4 The selection of the insertion site, either the internal

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Section: Discussionsupporting

confidence: 90%

The insertion site is the main risk factor for central venous catheter‐related complications in patients with hematologic malignancies

et al. 2022

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“…were reported in 73%, 15.5%, and 1%, respectively, in a recent multicenter study for both definite CRBSI and probable CRBSI combined in cancer patients [ 31 ]. Of note, the predominance of Gram-negative bacteria that had been described in other recent cohort studies using less cancer-specific definitions was not observed with the use of the definition of definite plus probable CRBSI [ 31 , 32 ].…”

Section: Resultsmentioning

confidence: 79%

“…Surveillance and cohort studies in cancer patients report CRBSI/CLABSI rates of 1.05–14.4 per 1000 CVC-days [ 6 , 41 , 66 – 68 ]. A recent pooled analysis of 1194 cancer patients derived from the German SECRECY registry and a prospective randomized trial testing an antimicrobial dressing in neutropenic cancer patients (COAT-trial) used the definitions of definite CRBSI and definite plus probable CRBSI, reporting an incidence of 2.7 and 6.7 for definite CRBSI and definite plus probable CRBSI per 1000 catheter-days, respectively [ 32 ]. Using the less stringent CDC definition, a CLABSI rate of 2.9–6.3 per 1000 CVC-days was reported in a recent randomized controlled trial in adult cancer patients testing different skin disinfectant solutions (alcohol-based solutions with or without octenidine) [ 37 , 69 ].…”

Section: Resultsmentioning

confidence: 99%

“…Overall, coagulase-negative staphylococci (CoNS) are the most commonly detected bacteria in cancer patients with CLABSI, followed by other Gram-positive bacteria such as Staphylococcus aureus , Enterococci, and Streptococci [ 44 , 74 – 77 ]. Accordingly, Schalk and colleagues recently reported a large multicenter cohort of 3000 cases of definitive and probable CRBSI in cancer patients from registry and trial data and found a similar distribution of pathogens as in smaller single-center studies with CoNS as the most common causative pathogens for CRBSIs [ 32 ]. The frequency of Gram-negative bacteria such as Escherichia coli , Pseudomonas aeruginosa , and Klebsiella spp.…”

Section: Resultsmentioning

confidence: 99%

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Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

et al. 2020

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Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter–related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.

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“…Epidemiological data on CRBSI derived from RCT may reliably be transferred to real-world settings. 6 However, to the best of our knowledge, there are no published RCT available so far comparing CRBSI rates of JV-CVC and SV-CVC in patients with hematological malignancies. Therefore, any evidence addressed here has to derive from secondary endpoints of RCT or from realworld multicenter studies, or registries, with adequate sample sizes.…”

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confidence: 99%

Jugular vein inserted central venous catheters (CVC) and the risk of CVC‐related bloodstream infections in patients with hematological malignancies

2022

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Central venous catheter–related bloodstream infections in patients with hematological malignancies: Comparison of data from a clinical registry and a randomized controlled trial

Cited by 8 publications

References 10 publications

The insertion site is the main risk factor for central venous catheter‐related complications in patients with hematologic malignancies

The insertion site is the main risk factor for central venous catheter‐related complications in patients with hematologic malignancies

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Jugular vein inserted central venous catheters (CVC) and the risk of CVC‐related bloodstream infections in patients with hematological malignancies

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