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Author Wolf, J.; Allison, K.J.; Tang, L.; Sun, Y.; Hayden, R.T.; Flynn, P.M. url  doi
openurl 
  Title No evidence of benefit from antibiotic lock therapy in pediatric oncology patients with central line-related bloodstream infection: results of a retrospective matched cohort study and review of the literature Type Journal Article
  Year 2014 Publication Pediatric Blood & Cancer Abbreviated Journal Pediatr Blood Cancer  
  Volume 61 Issue 10 Pages 1811-1815  
  Keywords Adolescent; Anti-Bacterial Agents/*administration & dosage; Catheter-Related Infections/*drug therapy; Catheterization, Central Venous/*adverse effects; Central Venous Catheters/adverse effects/microbiology; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Male; Pediatrics/methods; Retrospective Studies; Young Adult; bacteremia; catheter-related infections; catheterization, central venous; child  
  Abstract BACKGROUND: Long-term central venous catheters (CVCs) are essential to modern pediatric oncology practice, but central line-related bloodstream infection (CRBSI) is a frequent and important complication. CVC salvage is often attempted but treatment failure is common due to persistent infection, delayed catheter removal, or subsequent relapse of infection, which can be associated with significant morbidity and cost. Adjunctive antibiotic lock therapy (ALT) has been proposed to reduce the risk of treatment failure, but insufficient data are available to confirm efficacy of this intervention. PROCEDURE: We undertook a retrospective matched cohort study of ALT use for treatment of CRBSI in pediatric hematology/oncology patients at St. Jude Children's Research Hospital between 2006 and 2012. RESULTS: Thirty-eight eligible episodes of CRBSI treated with adjunctive ALT were identified and compared to 73 episodes treated with standard therapy (ST) alone, matched by catheter-type and organism. Overall, treatment failure was similar between ALT and ST groups (50.0 vs. 38.4%; P = 0.24), but the timing was different; in the ALT cohort, immediate CVC removal was less common (0.0 vs. 12.3%; P = 0.03) but delayed removal (4-13 days) and relapse of infection was more common (50.0 vs. 24.7%; P = 0.01). CONCLUSIONS: This retrospective study was unable to identify any benefit of adjunctive ALT in pediatric oncology patients with CRBSI. The available evidence does not support routine ALT use, and well-conducted prospective studies are needed.  
  Address Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee; University of Tennessee Health Sciences Center, Memphis, Tennessee; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1545-5009 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:24923808 Approved no  
  Call Number ref @ user @ Serial (down) 100515  
Permanent link to this record
 

 
Author Wolf, H.-H.; Leithauser, M.; Maschmeyer, G.; Salwender, H.; Klein, U.; Chaberny, I.; Weissinger, F.; Buchheidt, D.; Ruhnke, M.; Egerer, G.; Cornely, O.; Fatkenheuer, G.; Mousset, S. url  doi
openurl 
  Title Central venous catheter-related infections in hematology and oncology : guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) Type Journal Article
  Year 2008 Publication Annals of Hematology Abbreviated Journal Ann Hematol  
  Volume 87 Issue 11 Pages 863-876  
  Keywords Anti-Bacterial Agents/therapeutic use; Antifungal Agents/therapeutic use; *Bacteremia/diagnosis/drug therapy/prevention & control; Catheterization, Central Venous/*adverse effects/*standards; *Cross Infection/diagnosis/drug therapy/prevention & control; Humans; Microbiological Techniques/standards  
  Abstract Catheter-related infections (CRI) cause considerable morbidity in hospitalized patients. The incidence does not seem to be higher in neutropenic patients than in nonneutropenic patients. Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the pathogens most frequently cultured, followed by Candida species. Positive blood cultures are the cornerstone in the diagnosis of CRIs, while local signs of infection are not necessarily present. Blood cultures should be taken from peripheral blood and from the venous catheter. A shorter time to positivity of catheter blood cultures as compared with peripheral blood cultures supports the diagnosis of a CRI. In many cases, a definite diagnosis requires catheter removal and microbiological analysis. The role plate method with semiquantitative cultures has been established as standard in most laboratories. Antimicrobial treatment of CRI should be directed by the in vitro susceptibility of the isolated pathogen. Primary removal of the catheter is mandatory in S. aureus and Candida infections, as well as in case of tunnel or pocket infections. Future studies will elucidate whether the rate of CRI in neutropenic patients may be reduced by catheters impregnated with antimicrobial agents.  
  Address Klinik fur Innere Medizin IV, Onkologie, Hamatologie und Hamostaseologie, Martin-Luther-Universitat Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany. hans.wolf@medizin.uni-halle.de  
  Corporate Author Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0939-5555 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:18629501 Approved no  
  Call Number ref @ user @ Serial (down) 100514  
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Author Wirtschafter, D.D.; Padilla, G.; Suh, O.; Wan, K.; Trupp, D.; Fayard, E.E.S. url  doi
openurl 
  Title Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique Type Multicenter Study
  Year 2011 Publication Journal of Perinatology : Official Journal of the California Perinatal Association Abbreviated Journal J Perinatol  
  Volume 31 Issue 8 Pages 514-518  
  Keywords Anti-Bacterial Agents/*therapeutic use; Bacteremia/*drug therapy; Catheterization, Central Venous/*adverse effects; Catheters, Indwelling/adverse effects; Cross Infection/*drug therapy/*epidemiology/prevention & control; Drug Utilization; Humans; Infant, Newborn; *Intensive Care Units, Neonatal; Practice Patterns, Physicians'/*statistics & numerical data; Quality Indicators, Health Care  
  Abstract OBJECTIVE: To assess antibiotic use as a complementary neonatal intensive care unit (NICU) infection measure to the central line-associated blood stream infection (CLABSI) rate. STUDY DESIGN: Patient days (PDs), line days, antibiotic (AB) use, CLABSI and other proven infections were analyzed in consecutive admissions to two NICUs over 3 and 6 months, respectively, from 1 January 2008 until discharge. An antibiotic course (AC) consisted of one or more uninterrupted antibiotic days (AD), classified as perinatal or neonatal, if started </=3 d or >/=4 d post birth and as rule-out sepsis or presumed infection (PI) if treated </=4 d or >/=5d, respectively. Events were expressed per 1000 PD and aggregated by conventional treatment categories and by clinical perception of infection certainty: possible, presumed or proven. RESULT: The cohort included 754 patients, 18,345 PD, 6637 line days, 718 AC and 4553 AD. Of total antibiotic use, neonatal use constituted 39.2% of ACs, and 29.0% of ADs, When analyzed per 1000 PD, antibiotic use to treat PIs vs CLABSIs, was either 14 fold (CI 6.6-30) higher for ACs (5.40 vs 0.38/1000 PD, P<0.0001) or 8.8 fold (CI 7.1-11) higher for ADs (48.3 vs 5.5/1000 PD, P<0.0001). CONCLUSION: CLABSI rates, present a lower limit of NICU-acquired infections, whereas antibiotic-use measures, about 10-fold higher, may estimate an upper limit of that burden. Antibiotic-use metrics should be evaluated further for their ability to broaden NICU infection assessment and to guide prevention and antibiotic stewardship efforts.  
  Address David D Wirtschafter, MD, Inc., Valley Village, CA 91607, USA. david.wirtschafter@juno.com  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0743-8346 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:21546938 Approved no  
  Call Number ref @ user @ Serial (down) 100513  
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Author Wintenberger, C.; Epaulard, O.; Hincky-Vitrat, V.; Brion, J.P.; Recule, C.; Francois, P.; Stahl, J.P.; Pavese, P. url  doi
openurl 
  Title Outcome of central venous catheter-related bacteraemia according to compliance with guidelines: experience with 91 episodes Type Journal Article
  Year 2012 Publication The Journal of Hospital Infection Abbreviated Journal J Hosp Infect  
  Volume 80 Issue 3 Pages 245-251  
  Keywords Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents/administration & dosage/*therapeutic use; Bacteremia/diagnosis/*drug therapy/etiology/mortality; Catheterization, Central Venous/*adverse effects; Child; Child, Preschool; Female; France/epidemiology; *Guideline Adherence; Hospitals, University; Humans; Male; Middle Aged; *Practice Guidelines as Topic; Treatment Outcome; Young Adult  
  Abstract BACKGROUND: Infection is a major complication associated with the use of central venous catheters. Guidelines for medical management of catheter-related bacteraemia have been published, but no study has assessed the appropriateness of physician practices. AIM: To assess medical practices in cases of central venous catheter-related bacteraemia (CRB) in a university hospital. METHODS: Cases were recorded over a period of 12 months and their management was evaluated. All cases of positive blood cultures based on central venous catheter sampling were analysed, and episodes of CRB were determined in this group of patients. Medical management and patient outcome were analysed independently by two physicians. FINDINGS: In all, 187 cases of positive blood culture were recorded and 91 cases of CRB were analysed. Systemic antimicrobial therapy was optimal in 56% of the episodes. In 51 episodes, catheter salvage was attempted, for 29 with an indication in agreement with the guidelines but without antibiotic-lock therapy in 20 episodes. The overall medical management was appropriate in 41.8% of the episodes. The overall cure rate was 72.5%. CRB-related death occurred in 5.5% of the episodes. Cure was associated with guideline compliance (P = 0.03) and with adaptation of systemic antimicrobial therapy (P < 0.01). Conservative treatment success was associated with compliance with the guidelines for the indication (P = 0.01). CONCLUSION: Medical management of CRB did not closely adhere to international guidelines. CRB outcome was associated with the appropriateness of this management, particularly when conservative treatment was attempted.  
  Address Infectious Diseases Department, Grenoble University Hospital, Grenoble, France. CWintenberger@chu-grenoble.fr  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0195-6701 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:22230103 Approved no  
  Call Number ref @ user @ Serial (down) 100512  
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Author Winokur, E.J.; Pai, D.; Rutledge, D.N.; Vogel, K.; Al-Majid, S.; Marshall, C.; Sheikewitz, P. url  doi
openurl 
  Title Blood culture accuracy: discards from central venous catheters in pediatric oncology patients in the emergency department Type Journal Article
  Year 2014 Publication Journal of Emergency Nursing: JEN : Official Publication of the Emergency Department Nurses Association Abbreviated Journal J Emerg Nurs  
  Volume 40 Issue 4 Pages 323-329  
  Keywords California; *Central Venous Catheters; Child; Emergency Nursing/*methods; Emergency Service, Hospital; Humans; Neoplasms/*blood/complications; Pediatrics/methods; Phlebotomy/*methods; Reproducibility of Results; Sensitivity and Specificity; Sepsis/*blood/complications; Blood culture; Blood discards; Central venous catheter (CVC); Oncology; Research  
  Abstract INTRODUCTION: Lack of specific guidelines regarding collection of blood for culture from central venous catheters (CVCs) has led to inconsistencies in policies among hospitals. Currently, no specific professional or regulatory recommendations exist in relation to using, reinfusing, or discarding blood drawn from CVCs before drawing blood for a culture. Repeated wasting of blood may harm immunocompromised pediatric oncology patients. The purpose of this comparative study was to determine whether differences exist between blood cultures obtained from the first 5 mL of blood drawn from a CVC line when compared with the second 5 mL drawn. METHODS: During 2009-2011, 62 pediatric oncology patients with CVCs and orders for blood cultures to determine potential sepsis were enrolled during ED visits. Trained study nurses aseptically drew blood and injected the normally discarded first 5 mL and the second specimen (usual care) into separate culture bottles. Specimens were processed in the microbiology laboratory per hospital policy. RESULTS: Positive cultures were evaluated to assess agreement between specimen results and to determine that the identified pathogen was not a contaminant. Out of 186 blood culture pairs, 4.8% demonstrated positive results. In all positive-positive matches, the normal discard specimen contained the same organism as the usual care specimen. In 4 matches, the normally discarded specimen demonstrated notably earlier time to positivity (4 to 31 hours) compared with the usual care specimen, which resulted in earlier initiation of definitive antibiotics. DISCUSSION: These findings support the accuracy of the specimen that is normally discarded and suggest the need to reconsider its use for blood culture testing.  
  Address Fullerton and Orange, CA  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0099-1767 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:23816324 Approved no  
  Call Number ref @ user @ Serial (down) 100511  
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