Document Detail

Gram-negative organisms predominate in Hickman line-related infections in non-neutropenic patients with hematological malignancies.
MedLine Citation:
PMID:  18342947     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Catheter-related blood stream infections (CRBSI) cause significant morbidity and mortality in patients with hematological malignancies. Previous studies have identified a predominance of gram-positive organisms causing CRBSI but they included both neutropenic and non-neutropenic patients with solid organ and hematological malignancies. The aim of our study was to evaluate the incidence and microbiological profile of CRBSIs in a specific cohort of patients with hematological malignancies in their non-neutropenic phase of illness. METHODS: A detailed retrospective review was done from January 2003 to December 2005 on all patients with hematological malignancies who had double-lumen non-antibiotic impregnated tunneled CVCs (Hickman catheters) inserted in our hospital to identify those fulfilling our criteria for CRBSI episodes. RESULTS: Amongst 273 evaluable patients, 61 developed CRBSI on 70 occasions. In contrast to previous studies, there was a predominance of gram-negative infections (68%). The majority (73%) of initial CRBSI episodes required catheter removal within 7 days of onset. Vancomycin and cefepime was the most common initial antibiotic regimen used. CONCLUSIONS: This study highlights the predominance of gram-negative infections in our cohort of non-neutropenic patients with underlying hematological malignancies who had Hickman catheters whose lines were not salvageable in the majority of cases. Empiric monotherapy with an antimicrobial agent with broad spectrum gram-negative cover needs to be given upfront pending results of the nature and sensitivity of organisms identified.
L Chee; M Brown; J Sasadeusz; L MacGregor; A P Grigg
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Publication Detail:
Type:  Journal Article     Date:  2008-03-17
Journal Detail:
Title:  The Journal of infection     Volume:  56     ISSN:  1532-2742     ISO Abbreviation:  J. Infect.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7908424     Medline TA:  J Infect     Country:  England    
Other Details:
Languages:  eng     Pagination:  227-33     Citation Subset:  IM    
Department of Clinical Haematology and Bone Marrow Transplantation, The Royal Melbourne Hospital, Victoria, Australia.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Antibiotic Prophylaxis
Bacteremia / complications,  epidemiology*,  microbiology
Catheterization, Central Venous / adverse effects
Catheters, Indwelling / microbiology*
Cephalosporins / therapeutic use
Cohort Studies
Gram-Negative Bacteria / isolation & purification*
Gram-Negative Bacterial Infections / complications,  drug therapy,  epidemiology*
Hematologic Neoplasms / blood,  complications*,  microbiology
Middle Aged
Neutropenia / complications
Retrospective Studies
Vancomycin / therapeutic use
Victoria / epidemiology
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Cephalosporins; 1404-90-6/Vancomycin; 88040-23-7/cefepime

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