ABSTRACT
Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was 7.6+/-5.1 years old. The mean operation time was 67.4+/-21.3 minutes and C-arm fluoroscopy was used in 47(30.5%). The causes of Hickman catheter removal were termination of use in 82 (57.3%), catheter related bloodstream infection in 44(30.8%), mechanical malfunction in 11(7.7%), and accidents in 6(4.2%). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was 214.9+/-140.2 days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was 198.0+/-116.0 days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.
Subject(s)
Child , Humans , Anti-Bacterial Agents , Catheters , Central Venous Catheters , Fluoroscopy , Multivariate Analysis , Retrospective StudiesABSTRACT
Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T. pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HD. Fever resurged at 16th HD despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HD. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HD, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, urease-positive, and alkaline-slant/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T. pulmonis DSM 44142T. To our knowledge, this is the first report of T. pulmonis bacteremia in Korea.
Subject(s)
Adult , Humans , Male , Actinomycetales/classification , Actinomycetales Infections/diagnosis , Bacteremia/diagnosis , Bone Marrow Transplantation , Catheter-Related Infections/microbiology , Leukemia, Myeloid, Acute/therapy , Phylogeny , RNA, Ribosomal, 16S/geneticsABSTRACT
From Jul.1995 to Oct.2003, at HCM City Blood Transfusion and Hematology Hospital, Hickman catheter was inserted on 41 patients with AML,ALL,BMT,Thalassemia. Main complications were bacterial infections, which accounted for 14,9%. In addition, some events occured accidentally such as chocking up (7,3%), breaking (4,8)% of the cuff in removal of catheter
Subject(s)
Catheterization , Bacterial Infections , Device RemovalABSTRACT
Leclercia adecarboxylata and Escherichia hermannii are motile, gram-negative facultative anaerobic bacilli which have rarely been isolated from environmental and clinical specimens. Although several cases of L. adecarboxylata or E. hermannii infections have been reported, a confirmed case of Hickman catheter-associated bacteremia has, to our knowledge, never been reported. A 69-year old woman completed her fourth schedule of chemotherapy for the treatment of leiomyosarcoma and was discharged without complication. However, she suffered from fever and chills for three weeks soon after the completion of chemotherapy and visited the emergency department. A Hickman catheter was promptly removed and the catheter tip was submitted to semiquantitative culture, as well as three sets of blood cultures from three different peripheral veins. Mixed growth of L. adecarboxylata and E. hermannii was isolated from Hickman catheter tip culture and all three sets of blood cultures.