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Prediction of central venous catheter–related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified Infection Probability Score (mIPS)

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Abstract

The aim of this study was to predict the probability of central venous catheter–related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified version of the Infection Probability Score (mIPS). In order to perform a prospective, mono-centric surveillance of complications in clinical routine due to short-term central venous catheters (CVCs) in consecutive patients receiving chemotherapy from March 2013 to September 2014, IPS was calculated at CVC insertion and removal (mIPSin and mIPSex, respectively). We used the 2012 Infectious Diseases Working Party of the German Society of Haematology and Medical Oncology (AGIHO/DGHO) criteria to define CRBSI. In total, 143 patients (mean 59.5 years, 61.4 % male) with 267 triple-lumen CVCs (4044 CVC days; mean 15.1 days, range 1–60 days) were analysed. CVCs were inserted for therapy of acute leukaemia (53.2 %), multiple myeloma (24.3 %) or lymphoma (11.2 %), and 93.6 % were inserted in the jugular vein. A total of 66 CRBSI cases (24.7 %) were documented (12 definite/13 probable/41 possible). The incidence was 16.3/1000 CVC days (2.9/3.1/10.1 per 1000 CVC days for definite/probable/possible CRBSI, respectively). In CRBSI cases, the mIPSex was higher as compared to cases without CRBSI (13.1 vs. 7.1; p < 0.001). The best mIPSex cutoff for CRBSI prediction was 8 points (area under the curve (AUC) = 0.77; sensitivity = 84.9 %, specificity = 60.7 %, negative predictive value = 92.4 %). For patients with an mIPSex ≥8, the risk for a CRBSI was high (odds ratio [OR] = 5.9; p < 0.001) and even increased if, additionally, CVC had been in use for about 10 days (OR = 9.8; p < 0.001). In case other causes of infection are excluded, a mIPSex ≥8 and duration of CVC use of about 10 days predict a very high risk of CRBSI. Patients with a mIPSex <8 have a low risk of CRBSI of 8 %.

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References

  1. Dettenkofer M, Ebner W, Bertz H, Babikir R, Finke J, Frank U, Rüden H, Daschner FD (2003) Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transplant 31:795–801

    Article  CAS  PubMed  Google Scholar 

  2. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB (2003) Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 36:1103–1110

    Article  PubMed  Google Scholar 

  3. Boersma RS, Jie KS, Verbon A, van Pampus EC, Schouten HC (2008) Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Ann Oncol 19:433–442

    Article  CAS  PubMed  Google Scholar 

  4. Ziegler MJ, Pellegrini DC, Safdar N (2015) Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 43:29–36

    Article  PubMed  Google Scholar 

  5. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC) (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hentrich M, Schalk E, Schmidt-Hieber M, Chaberny I, Mousset S, Buchheidt D, Ruhnke M, Penack O, Salwender H, Wolf HH, Christopeit M, Neumann S, Maschmeyer G, Karthaus M, Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (2014) Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Ann Oncol 25:936–947

    Article  CAS  PubMed  Google Scholar 

  7. Peres Bota D, Mélot C, Lopes Ferreira F, Vincent JL (2003) Infection Probability Score (IPS): A method to help assess the probability of infection in critically ill patients. Crit Care Med 31:2579–2584

    Article  PubMed  Google Scholar 

  8. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    Article  CAS  PubMed  Google Scholar 

  9. Seifert H, Abele-Horn M, Fätkenheuer G, Glück T, Jansen B, Kern WV, Mack D, Plum G, Reinert RR, Roos R, Salzberger B, Shah PM, Ullmann U, Weiß M, Welte T, Wisplinghoff H, Mikrobiologisch-infektiologische Qualitätsstandards (MiQ) (2007) Blutkulturdiagnostik – Sepsis, Endokarditis, Katheterinfektionen, Teil 1. Urban & Fischer, Munich

    Google Scholar 

  10. Link H, Böhme A, Cornely OA, Höffken K, Kellner O, Kern WV, Mahlberg R, Maschmeyer G, Nowrousian MR, Ostermann H, Ruhnke M, Sezer O, Schiel X, Wilhelm M, Auner HW, Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO); Group Interventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG-German Cancer Society) (2003) Antimicrobial therapy of unexplained fever in neutropenic patients--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study Group Interventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG-German Cancer Society). Ann Hematol 82(Suppl 2):S105–S117

    Article  CAS  PubMed  Google Scholar 

  11. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum, Hillsdale

    Google Scholar 

  12. Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240:1285–1293

    Article  CAS  PubMed  Google Scholar 

  13. Martini A, Gottin L, Mélot C, Vincent JL (2008) A prospective evaluation of the Infection Probability Score (IPS) in the intensive care unit. J Infect 56:313–318

    Article  PubMed  Google Scholar 

  14. Apostolopolou E, Raftopoulos V, Terzis K, Pissaki K, Pagoni M, Delibasi S (2010) Infection probability score, APACHE II and KARNOFSKY scoring systems as predictors of infection onset in haematology-oncology patients. J Clin Nurs 19:1560–1568

    Article  PubMed  Google Scholar 

  15. Apostolopoulou E, Raftopoulos V, Terzis K, Elefsiniotis I (2010) Infection Probability Score, APACHE II and KARNOFSKY scoring systems as predictors of bloodstream infection onset in hematology-oncology patients. BMC Infect Dis 10:135

    Article  PubMed Central  PubMed  Google Scholar 

  16. Apostolopoulou E, Raftopoulos V, Terzis K, Elefsiniotis I (2011) Infection Probability Score: a predictor of Clostridium difficile-associated disease onset in patients with haematological malignancy. Eur J Oncol Nurs 15:404–409

    Article  PubMed  Google Scholar 

  17. Ratzinger F, Schuardt M, Eichbichler K, Tsirkinidou I, Bauer M, Haslacher H, Mitteregger D, Binder M, Burgmann H (2013) Utility of sepsis biomarkers and the infection probability score to discriminate sepsis and systemic inflammatory response syndrome in standard care patients. PLoS One 8, e82946

    Article  PubMed Central  PubMed  Google Scholar 

  18. Safavi M, Honarmand A (2007) Comparison of infection probability score, APACHE II, and APACHE III scoring systems in predicting need for ventilator and ventilation duration in critically ill patients. Arch Iran Med 10:354–360

    PubMed  Google Scholar 

  19. Honarmand A, Safavi M, Moradi D (2009) The use of infection probability score and sequential organ failure assessment scoring systems in predicting mechanical ventilation requirement and duration. Ulus Travma Acil Cerrahi Derg 15:440–447

    PubMed  Google Scholar 

  20. Raad I (1998) Intravascular-catheter-related infections. Lancet 351:893–898

    Article  CAS  PubMed  Google Scholar 

  21. Worth LJ, Black J, Seymour JF, Thursky KA, Slavin MA (2008) Surveillance for catheter-associated bloodstream infection in hematology units: quantifying the characteristics of a practical case definition. Infect Control Hosp Epidemiol 29:358–360

    Article  PubMed  Google Scholar 

  22. Bénet T, Vanhems P (2009) Correlation of nosocomial bloodstream infection incidences: an ecological study. J Hosp Infect 73:217–224

    Article  PubMed  Google Scholar 

  23. Mollee P, Jones M, Stackelroth J, van Kuilenburg R, Joubert W, Faoagali J, Looke D, Harper J, Clements A (2011) Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect 78:26–30

    Article  CAS  PubMed  Google Scholar 

  24. Crnich CJ, Maki DG (2002) The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis 34:1232–1242

    Article  PubMed  Google Scholar 

  25. Cobb DK, High KP, Sawyer RG, Sable CA, Adams RB, Lindley DA, Pruett TL, Schwenzer KJ, Farr BM (1992) A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 327:1062–1068

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank all patients who participated in this study as well as the physicians and nurses of our department for their collaboration.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Enrico Schalk, Lynn Hanus, Thomas Fischer & Florian H. Heidel

  2. Department of Medical Microbiology, Infection Control and Prevention, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany

    Jacqueline Färber

Authors
  1. Enrico Schalk
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  2. Lynn Hanus
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  3. Jacqueline Färber
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  4. Thomas Fischer
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  5. Florian H. Heidel
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Correspondence to Enrico Schalk.

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Schalk, E., Hanus, L., Färber, J. et al. Prediction of central venous catheter–related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified Infection Probability Score (mIPS). Ann Hematol 94, 1451–1456 (2015). https://doi.org/10.1007/s00277-015-2387-y

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  • DOI: https://doi.org/10.1007/s00277-015-2387-y

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