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Acutely ill hematology/oncology patients with central-line associated bloodstream infections and the impact of timing of catheter removal on outcomes

Published:November 11, 2021DOI:https://doi.org/10.1016/j.ajic.2021.10.038

      Highlights

      • Patients with malignancies at risk central line-associated blood infections and subsequent develop complications
      • Catheters are removed during hospitalization in the majority of acutely ill hematology-oncology patients with CLABSI (86.5%) with median time to removal of 11.8 hours
      • Catheter removal greater than 12 hours from culture result trended towards poorer outcomes, although differences were not statistically significant
      • Further investigation is warranted to determine the optimal timing of catheter removal in hematology-oncology with CLABSI

      Background

      Hematology/oncology patients are at risk for central line-associated bloodstream infections (CLABSI). The purpose was to determine if infection-related mortality, persistent bacteremia, and recurrent bacteremia were decreased with early central venous catheter (CVC) removal.

      Methods

      A case-matched, retrospective cohort study was conducted comparing patients with early catheter removal (≤12 hours) to late catheter removal (>12 hours) in hematology/oncology patients with CLABSI from June 1, 2015 to May 31, 2018. Patients were case-matched based on intensive care unit admission and presence of shock to control for severity of illness.

      Results/Discussion

      Of 148 patients meeting study inclusion, 128 (86.5%), had their CVC removed during hospitalization (median 11.8 hours). The majority had a hematologic malignancy (90.5%). Following case-matching, 48 patients remained in each group. The primary outcome of infection-related mortality, persistent bacteremia, or recurrent bacteremia occurred more frequently in the late catheter removal group compared to the early catheter removal group although this was not statistically significant (18.8% vs 8.3%, P = .136).

      Conclusions

      A lower incidence of infection-related mortality, persistent bacteremia, and recurrent bacteremia was found in patients early catheter removal; however the sample size was not adequate to detect statistical differences. Investigators should continue to evaluate if early catheter removal confers a benefit in a larger patient population.

      Graphical abstract

      Key Words

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