ABSTRACT
The aims of this study were to assess the incidence and risk factors of major central venous catheter (CVC)-related complications in a large cohort of children affected by oncological, hematological, or immunological diseases in a 7-year prospective observational study at a single center. Nine hundred fifteen CVCs were inserted in 748 children for a total period of 307,846 CVC-days. Overall, 298 complications were documented with a complication rate of 0.97/1,000 CVC-days: 105 mechanical complications (dislocations 0.30/1,000 CVC-days, ruptures 0.04/1,000 CVC-days), 174 infections (bloodstream infections 0.46/1,000 CVC-days, tunnel infections 0.10/1,000 CVC-days), and 19 thrombosis (0.06/1,000 CVC-days). Significant risk factors were: diagnosis of acute lymphoblastic leukemia (ALL) and age Subject(s)
Catheterization, Central Venous/adverse effects
, Hematologic Diseases/therapy
, Infections/epidemiology
, Neoplasms/therapy
, Upper Extremity Deep Vein Thrombosis/epidemiology
, Catheterization, Central Venous/instrumentation
, Child
, Equipment Design
, Female
, Hematologic Diseases/complications
, Hospitals, Pediatric
, Humans
, Incidence
, Infections/microbiology
, Male
, Neoplasms/complications
, Prospective Studies
, Risk Factors
, Sepsis/epidemiology
ABSTRACT
This study is a retrospective analysis of seven patients with hypoechogenic lesions in the liver and/or spleen due to Bartonella henselae, who were followed from 1998 through to 2005 by the Department of Pediatrics, Turin University. In addition to showing constitutional symptoms, four children had skin lesions suggestive of injuries inflicted by cats, and one child had a history of exposure to cats. The origin of the infection remained undefined in the other two patients. Humoral tests enabled a precise diagnosis in all children. Treatment with macrolides or combinations of two active antibiotics for at least 2-3 weeks led to the definitive clearance of infection, although residual intraparenchymal lesions persisted in five patients for several months or years. Conclusion B. henselae serology allows an easy diagnosis of multiple hepatosplenic granulomata, a clinical picture that appears to be under-recognized. Macrolides or a combination of two active antibiotics for 2-3 weeks leads to a rapid clinical response and a definitive clearance of infection.
Subject(s)
Cat-Scratch Disease/complications , Granuloma/etiology , Liver Diseases/etiology , Splenic Diseases/etiology , Adolescent , Bartonella henselae/genetics , Bartonella henselae/isolation & purification , Biopsy , Cat-Scratch Disease/diagnosis , Cat-Scratch Disease/microbiology , Child , Child, Preschool , DNA, Bacterial/analysis , Diagnosis, Differential , Follow-Up Studies , Granuloma/diagnosis , Humans , Liver Diseases/diagnosis , Polymerase Chain Reaction , Retrospective Studies , Splenic Diseases/diagnosis , Time Factors , Tomography, X-Ray ComputedABSTRACT
Tunnel infection is an uncommon but serious complication observed in patients with partially implanted central venous catheters. International guidelines suggest that should include antibiotics and catheter removal. A success rate of only 5-20% was reported without catheter removal. We treated 13 episodes of tunnel Gram-positive bacterial infection occurring in pediatric patients with cancer or serious blood disorders with 24-hr intra-catheter antibiotic continuous infusion. This approach led to a 69% success rate. Continuous infusion might be an attractive option to treat tunnel Gram-positive bacterial infections when catheter removal might not be feasible or advisable.
