Summary
We reviewed the records of 23 pediatric patients who had received at least one central venous catheter during a two-year period. Nine patients had acute lymphoblastic leukemia (ALL), nine had other hematologic/oncologic diagnoses, and five had cystic fibrosis. Twenty-nine of 65 febrile episodes in 16 patients were associated with a catheter-related infection. Twenty of 40 catheters were associated with an infection over a period of 7,229 catheter days. For every 1,000 catheter days, four episodes of infections were observed. The number of infections/1,000 catheter days, the average life of a catheter (℞ 180 days), and mean number of days elapsing before the first infection were not significantly different in the three diagnostic groups. Broviac catheters were used most often (24/40), followed by Quinton (9/40) and Port-a-Cath (7/40). Broviac catheters lasted twice as long (224 days, p<0.01) as Quinton and Porta-a-Cath. Grampositive cocci were isolated most frequently andStaphylococcus epidermidis was the most common pathogen. No consistent relationship between an absolute neutrophil count of <1,000/mm3 and infection with gram-positive cocci was seen. However, seven of eight episodes of gram-negative bacillary infections occurred in patients with an absolute neutrophil count of <1,000/m3 (p<0.005). Those patients who were not considered terminally ill responded well to antimicrobials. Catheter removal was necessary in only two instances.
Zusammenfassung
Bei 23 pädiatrischen Patienten (neun Kindern mit akuter lymphoblastischer Leukämie, neun mit anderen malignen hämatologischen Erkrankungen oder Tumoren und fünf Kindern mit zystischer Fibrose) war im Zeitraum von zwei Jahren mindestens ein Zentralvenenkatheter gelegt worden. Die Krankengeschichten dieser Kinder wurden retrospektiv ausgewertet. Bei 16 Patienten traten insgesamt 65 Fieberepisoden auf, in 29 Fällen bestand eine Katheter-assoziierte Infektion. 20 von 40 Kathetern mit einer Gesamtverweildauer von 7229 Kathetertagen waren infiziert. Im Mittel kamen 4,0 Infektionen auf 1000 Kathetertage. In den drei Diagnosegruppen waren keine Unterschiede bezüglich der Anzahl der Infektionen/1000 Kathetertage, der durchschnittlichen Katheterverweildauer (etwa 180 Tage) oder der mittleren Anzahl von Tagen bis zum Auftreten der ersten Infektion festzustellen. Am häufigsten wurden Broviac-Katheter verwendet (24/40), es folgten Quinton-Katheter (9/40) und Port-a-Cath (7/40). Die Liegedauer der Broviac-Katheter war doppelt so lang (224 Tage) wie die der Quinton- oder Port-a-Cath-Modelle (p<0,01). Am häufigsten wurden grampositive Kokken aus den infizierten Kathetern isoliert, der häufigste Erreger warStaphylococcus aureus. Absolute Granulozytenzahlen unter 1000/mm3 standen nicht in Korrelation zur Infektionshäufigkeit mit grampositiven Kokken; jedoch waren sieben der acht Infektionen mit gramnegativen Stäbchen bei Patienten mit einer absoluten Granulozytenzahl von weniger als 1000/mm3 (p<0,005) aufgetreten. Patienten, die nicht im terminalen Krankheitsstadium waren, sprachen auf Antibiotika gut an. Nur in zwei Fällen mußte der Katheter entfernt werden.
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Kumar, A., Brar, S.S., Murray, D.L. et al. Central venous catheter infections in pediatric patients — in a community hospital. Infection 16, 86–90 (1988). https://doi.org/10.1007/BF01644309
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DOI: https://doi.org/10.1007/BF01644309