BACKGROUND: Septic thrombophlebitis increases patient morbidity and mortality following metastatic infections, pulmonary emboli, and/or septic shock. Central venous catheter (CVC) removal for occult septic thrombophlebitis challenges current strategy in neutropenic patients. PATIENTS AND METHODS: We prospectively evaluated infection-related mortality in 100 acute leukemia patients, with CVC-related bloodstream infection (CRBSI) after chemotherapy, who systematically underwent ultrasonography to identify the need for catheter removal. Their infection-related mortality was compared with that of a historical cohort of 100 acute leukemia patients, with CRBSI after chemotherapy, managed with a clinically driven strategy. Appropriate antimicrobial therapy was administered in all patients analyzed. RESULTS: In the prospective series, 30/100 patients required catheter removal for ultrasonography-detected septic thrombophlebitis after 1 median day from BSI onset; 70/100 patients without septic thrombophlebitis retained their CVC. In the historical cohort, 60/100 patients removed the catheter (persistent fever, 40 patients; persistent BSI, 10 patients; or clinically manifest septic thrombophlebitis, 10 patients) after 8 median days from BSI onset; 40/100 patients retained the CVC because they had not clinical findings of complicated infection. At 30 days median follow-up, one patient died for infection in the ultrasonography-assisted group versus 17 patients in the historical cohort (P<0.01). With the ultrasonography-driven strategy, early septic thrombophlebitis detection and prompt CVC removal decrease infection-related mortality, whereas clinically driven strategy leads to inappropriate number, reasons, and timeliness of CVC removal. CONCLUSION: Ultrasonography is an easy imaging diagnostic tool enabling effective and safe management of patients with acute leukemia and CRBSI.
BACKGROUND:Septic thrombophlebitis increasespatient morbidity and mortality following metastatic infections, pulmonary emboli, and/or septic shock. Central venous catheter (CVC) removal for occult septic thrombophlebitis challenges current strategy in neutropenicpatients. PATIENTS AND METHODS: We prospectively evaluated infection-related mortality in 100 acute leukemiapatients, with CVC-related bloodstream infection (CRBSI) after chemotherapy, who systematically underwent ultrasonography to identify the need for catheter removal. Their infection-related mortality was compared with that of a historical cohort of 100 acute leukemiapatients, with CRBSI after chemotherapy, managed with a clinically driven strategy. Appropriate antimicrobial therapy was administered in all patients analyzed. RESULTS: In the prospective series, 30/100 patients required catheter removal for ultrasonography-detected septic thrombophlebitis after 1 median day from BSI onset; 70/100 patients without septic thrombophlebitis retained their CVC. In the historical cohort, 60/100 patients removed the catheter (persistent fever, 40 patients; persistent BSI, 10 patients; or clinically manifest septic thrombophlebitis, 10 patients) after 8 median days from BSI onset; 40/100 patients retained the CVC because they had not clinical findings of complicated infection. At 30 days median follow-up, one patient died for infection in the ultrasonography-assisted group versus 17 patients in the historical cohort (P<0.01). With the ultrasonography-driven strategy, early septic thrombophlebitis detection and prompt CVC removal decrease infection-related mortality, whereas clinically driven strategy leads to inappropriate number, reasons, and timeliness of CVC removal. CONCLUSION: Ultrasonography is an easy imaging diagnostic tool enabling effective and safe management of patients with acute leukemia and CRBSI.
Authors: Roberta Della Pepa; Claudio Cerchione; Novella Pugliese; Roberta Colicchio; Paola Salvatore; Cesare Sirignano; Ernesto Soscia; Livio Pagano; Maurizio Sanguinetti; Fabrizio Pane; Marco Picardi Journal: Support Care Cancer Date: 2018-03-09 Impact factor: 3.603
Authors: A Richters; M van Vliet; P G M Peer; P E Verweij; B A P Laros-van Gorkom; N M A Blijlevens; J P Donnelly; W J F M van der Velden Journal: Bone Marrow Transplant Date: 2013-11-04 Impact factor: 5.483
Authors: Novella Pugliese; Paola Salvatore; Dora Vita Iula; Maria Rosaria Catania; Federico Chiurazzi; Roberta Della Pepa; Claudio Cerchione; Marta Raimondo; Claudia Giordano; Luigia Simeone; Simona Caruso; Fabrizio Pane; Marco Picardi Journal: Cancer Med Date: 2017-05-26 Impact factor: 4.452
Authors: Rita Wilson Dib; Anne-Marie Chaftari; Ray Y Hachem; Ying Yuan; Dima Dandachi; Issam I Raad Journal: Open Forum Infect Dis Date: 2018-10-01 Impact factor: 3.835