Hickman Catheter Research Articles

Scars of survivorship.

Let me show you my scar,” the twenty-something woman said to her fellow cancer survivor friend, as she pulled the top of her v-neck shirt diagonally to show the scar where her Hickman catheter had been.“This is where I had my PICC line,” the other survivor said, straightening her arm to show the remnant of a former IV site. And their conversation went on. They were engrossed in each other’s cancer survivor stories.

Damage of Central Catheters in Home Parenteral Nutrition Patients

According to the ESPEN and ASPEN guidelines, in the case of a long-term (>3-month) parenteral nutrition should be administered via a subcutaneous central venous catheter (CVC). There are three types of mechanical complications of tunnelled central catheter: catheter rupture, occlusion by TPN depositing and thrombofibrotic occlusion. The aim of the study was to analyse the incidence of complications central catheter in a group of patients receiving HPN. Between January 2010 and June 2014, HPN was conducted in 584 patients (306 women and 278 men), ninety-nine patients were enrolled in the study: 67 women and 32 men in whom mechanical complications of central catheters were found. Among 99 patients, 71 used the tunnelled Broviac catheter. Groshong catheters were placed only in patients receiving parenteral nutrition due to cancer. Analyses have shown differences between the older and younger in the number of mechanical complications. Younger patients were found to have a larger number of catheter complications (1.6 ± 1.1) in comparison with older patients (1.3 ± 0.7). The catheter that was most commonly damaged was the Broviac catheter 76.8%. The most frequent type of mechanical complications was catheter rupture 64.81%. Mechanical complications of tunnelled central catheters in HPN patients can be repaired in an outpatient setting in half of the cases, which enables continuation of parenteral nutrition without the need to hospitalise the patient. The centres that conduct HPN should offer 24-hour care and help in case of problems with the central venous line to the patients.

Efficacy of Single-stage Revision with Aggressive Debridement Using Intra-articular Antibiotics in the Treatment of Infected Joint Prosthesis.

Prosthetic joint infections (PJI) of the hip and knee are uncommon, but result in significant morbidity and mortality when they do occur. Current management consists of a combination of either single- or two-stage exchange of the prosthesis and/or exchange of polymer components with intravenous (IV) antibiotics (4–6 weeks) and intraoperative debridement of the joint prior to reimplantation. However, failure rate, morbidity, and expense associated with current management are high, especially if the infection involves resistant pathogens and/or osteomyelitis. Also, the current use of systemic antibiotics does not allow for high local concentrations of the drug and biofilm penetration of the infected prosthesis. To overcome these difficulties, we examined the outcomes of aggressive operative debridement of the infected prosthesis. This was achieved through the use of a single-stage revision and administration of high concentrations of local intra-articular antibiotics via Hickman catheters. We present 57 patients with PJI who were treated with intra-articular antibiotics and single-stage revisions. Minimal systemic toxicity was observed along with a 100% microbiologic cure rate and 89% without relapse at 11-month follow-up despite isolation of multidrug resistant pathogens. This is the largest study to date using this method in the treatment of PJI.

PO-0348 The Relationship Between Broviac Lines And Catheter Associated Blood Stream Infection

Background Broviac lines are a common source of catheter-associated bloodstream infection (CABSI) in our 22-bed tertiary paediatric intensive care unit (PICU). Aims To assess data in Broviac lines CABSI cases Methods Prospective clinical and laboratory data on all PICU admissions for 24 months (3/2010–3/2012), missing data was supplemented retrospectively using electronic patient records. The UK National Patient Safety Association ‘Matching Michigan’ case definitions were utilised to identify bloodstream infections and CABSI. The study was approved by the Clinical Audit Department- a division of the Directorate of Research and Clinical Development at Alder Hey Children’s Hospital. Results PICU-acquired CABSI rate was 7.35 per 1000 central line days. Device utilisation ratio (CVC days per patient days) was 0.77. Central line associated with CABSI: Broviac line 23 (39%); Triple lumen CVC femoral 14 and jugular 13; ECMO circuit 4; Renal/Vascatheter 3; Portacath 2. Conclusions In our patient population Broviac lines are commonly associated with CABSI and especially in less than one year age group.

1000 Port-A-Cath ® placements by subclavian vein approach: single surgeon experience.

Totally implantable venous access ports are widely used for the administration of chemotherapy in patients with cancer. Although there are several approaches to implantation, here we describe Port-A-Cath(®) (PAC) placement by percutaneous puncture of the subclavian vein with ultrasonographic guidance. Data on our vascular access service were collected prospectively from June 2004. This service included port-a-caths and Hickman lines. Once 1000 consecutive port-a-caths(®) had been reached the study was closed and data analysed for the port-a-caths(®) alone. The left subclavian vein was the preferred site for venous access, with the right subclavian and jugular veins being the alternative choices if the initial approach failed. Patients were followed up in the short-term, and all the procedures were carried out by a single surgeon at each one of two institutions. Venous access by PAC was established in 100 % of the 1,000 cases. Of the 952 patients where the left subclavian vein was chosen for the first attempt of puncture, the success rate of PAC placement was 95 % (n = 904). Pneumothorax occurred in 12 patients (1.2 %), and a wound haematoma occurred in 4 (0.4 %) out of the total 1,000 patients. No infections were recorded during the immediate post-operative period but only in the long-term post-operative use with 8 patients requiring removal of the PAC due to infection following administration of chemotherapy. This is a very large series of PAC placement with an ultrasound-guided approach for left subclavian vein and X-ray confirmation, performed by a single surgeon, demonstrating both the safety and effectiveness of the procedure.

Infantile Crohn's disease is one of the risk factors for catheter‐related bloodstream infection

Central venous catheterization is recognized as a lifeline that is important for chemotherapy or nutritional support in pediatric patients with malignant disease and intestinal failure. This study analyzed the risk of infection with Broviac line use among these patients at a single Japanese center. Two hundred and four Broviac lines were inserted in patients in the pediatric ward from January 2003 to October 2011. We analyzed the risk of catheter-related bloodstream infection (CR-BSI) using clinical characteristics including underlying disease, sepsis history, inserted situation, drug use, and laboratory data at the time of Broviac insertion or before CR-BSI. During the study period, data from a total of 15 lines were excluded because of missing blood culture data. In the remaining 189 Broviac lines, 52 lines developed CR-BSI. On univariate analysis, leukemia, infantile Crohn's disease, sepsis history before Broviac insertion, existence of a stoma opening, and immunosuppressant use before CR-BSI were risk factors for CR-BSI. On multivariate logistic regression analysis infantile Crohn's disease, sepsis history before Broviac insertion, and immunosuppressant use before CR-BSI were independently associated with CR-BSI (P = 0.015, P = 0.045, and P = 0.043, respectively). Infantile Crohn's disease carries a high risk for CR-BSI because of its pathological condition, the therapeutic drugs required, and surgical intervention.

Introduction of vincristine mini-bags and an assessment of the subsequent risk of extravasation.

Numerous international organisations have advocated the preparation of vincristine in small volume intravenous bags in order to eliminate inadvertent intrathecal administration. However, the risk of extravasation is a significant deterrent, and adoption of this practice has been variable and only hesitantly accepted in the clinical setting. We carried out a study with the aims of establishing the incidence of reported extravasation of vincristine administration to paediatric and adult patients in mini-bags; here we describe motivating factors and barriers faced by clinical staff. The secondary aim was to support the need for change and implementation of the international recommendations. Chemotherapy-certified nurses completed a survey spanning August 2009 to August 2011, to ascertain the incidence of extravasation associated with the administration of vincristine in mini-bags. This period captured 421 occasions of vincristine administration in 25-ml or 50-ml mini-bags (in 0.9% sodium chloride). The median age of patients was 13 years (range 2.5 months to 99 years). Vincristine was administered through peripheral lines (26.4%), portacath (52.0%), PICC line (15.9%) and Hickman line (5.7%). The majority of infusions were over at least 10 minutes (50.1%). There were no cases of extravasation reported. The administration of vincristine in small volume intravenous bags was safe, practical, and feasible in all patient groups. The successful implementation of the international recommendations for vincristine administration in mini-bags to eliminate potential inadvertent intrathecal administration was dependent on stakeholder buy-in.

Do we give too much or too little?

Introduction Over the last decade, information for cancer patients has become increasingly more available. The very nature of cancer requires patients to learn about their disease in order to cope with the consequences of treatment and to be involved in decision making processes. It is therefore vital to provide enough information for patients and their relevant others. People/patients vary in the amount of information they require. Evidence suggests that some patients do not want very much information about their diseases and treatments. This study aims to explore how much information our patient group wants to know and how much information our team provides. Method A questionnaire was prepared to collect data on how much information was given to patients on three different stages of their treatment plans. These stages were: on admission, during their inpatient stay and on discharge. A fourth section was added, to investigate other information that patient felt would be beneficial. 112 questionnaires were given between May 2010 and October 2012, outcome data is shown in Table I. Stage Information provided on the following topics N, % On admission1. Side effects of therapy or chemotherapy 39 (34.8%)2. Procedures (Bone Marrow Aspiration, Hickman Line insertion etc) 35(31.2%)3. Sexuality 11(9.8%)4. Fertility 13(11.6%)5. Results of diagnostic test 49(43.7%)6. Follow up, appointments 39(34.8%)7. Diet 23(20.5%) other 0(0%) During their stay1. Side effects of therapy or chemotherapy 41(36.6%)2. Procedures (Bone Marrow Aspiration, Hickman Line insertion etc) 39(34.8%)3. Infection Control 48(42.8%)4. Sexuality 9(8%)5. Fertility 11(9.8%)6. Results of diagnostic test 59(52.7%)7. others, blood tests 7(6.2%) On discharge1. Outcome of your treatment 65(58%)2. Follow up, appointment 102(91%)3. Medication 108(96.4%)4. What happens next 88(78.5%)5. When to call the medical team (Hospital) 94(83.9%)6. Work life 68(60.7%)7. Other alternative treatment regimens 8(7.1 %)Total 112 (100%) 112 malignant haematology patients were admitted to our unit for various reasons Our audit was evaluated in three different stages. The admission stage; most of the information provided regarded side effects of treatment and test results (See Table I). Our audit has shown that, the admission stage was the lowest in terms of information providing. It should be kept in mind that the haematology patient group generally has a long hospitalisation, the data collection tool was given on discharge. Therefore, it was interpreted that data might be lost due to poor recall of the information required. We are now giving the data collection tool on admission rather than on discharge in an effort to address this matter. Result showed that Sexuality (9.8%) and fertility (11.6%) were the least addressed topics; where as results of diagnostic test (43.7%) was deemed the most important. On the other hand results also showed our patient were happy about the information they were given especially on discharge, as most aspects of information was covered. For the haematology patient group, knowing their diseases and potential outcomes does help in the difficult decision making process of their treatment. Therefore as healthcare professionals it is our duty of care to provide the information they need, but how far do we need to go? This study was aimed at exploring our patient groups information needs as well as providing a self performance check. Our audit showed that our centre does perform well in admission and discharge stages; we need to work on the in patient period. In order to collect the required data, we have decided to give patients the data collection tool on admission rather than discharge.

A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients

Peripherally inserted central venous catheters (PICC) have become increasingly popular for medium to long-term parenteral nutrition (PN) but there is limited data on the complication rates in this sub-group. We aimed to compare the rates of complications associated with tunneled catheters (Broviac) and PICC in home PN (HPN) patients. All adult patients in an HPN program with a new Broviac or new PICC between 2009 and 2011 were included in this prospective observational study. Complication rates were compared by using Poisson regression and Kaplan Meier survival curves were used to compare the first complications that occurred. 204 catheters (133 Broviac and 71 PICC) were inserted in 196 adult patients. Mean follow-up from catheter insertions to their removal was 276 ± 219 days for Broviac (n = 86) vs. 74 ± 140.70 days for PICC (n = 56); p < 0.001. Complications were similar between Broviac and PICC (91/133 vs. 26/71). Catheter infection rate was lower in PICC (1.87 vs. 1.05 per 1000 catheter-days; p = 0.01). Catheter obstruction rates were similar for both catheters. Only PICC experienced venous thrombosis (0.4/1000). The proportion of catheters removed was lower in the Broviac group than in the PICC group (62.4% vs. 78.8%; p = 0.01) but those removed for complications were not different (28.6.7%vs. 25.3%; p = 0.64). In HPN patients, overall complications were similar in both the PICC and the Broviac groups. However, the Broviac catheter could be associated with an increase in catheter infection.

Cost and Safety of Pediatric Intensive Care Physician-Placed Broviac Catheters

To compare the cost and safety of placement of Broviac catheters in children by pediatric intensivists in a sedation suite versus placement by pediatric surgeons in the operating room. Single-center retrospective analysis. Pediatric sedation suite and operating rooms in a tertiary care children's hospital. All pediatric patients with Broviac catheters placed (n = 253) at this institution over a 3-year period from 2007 to 2009. None. We reviewed the charts of all pediatric patients with Broviac catheters placed, either by intensivists or surgeons, and compared cost and outcomes. Procedure safety was assessed and categorized into immediate, short-term (within 2 wk of procedure), and long-term outcomes. Anesthetic safety and billing data for the procedure were also collected. Among similar patient populations, immediate complications, such as pneumothorax, procedure failure (p > 0.999), and anesthetic complications (p = 0.60), were not significantly different. Short-term outcomes, including infection (p = 0.27) and catheter malfunction (p > 0.999), were not different. Long-term outcomes, including mean indwelling catheter days (p = 0.60) and removal due to catheter infection (p = 0.09), were not different between the groups. Overall cost of the procedure was significantly different: $7,031 (± $784) when performed by surgeons and $3,565 (± $311) when performed by intensivists (p < 0.001). Pediatric critical care physicians can place Broviac catheters as safely as pediatric surgeons and at a lower cost in a defined patient population.

Letter to the Editor A 53-year-old woman with thrombocytosis and pulmonary embolism

Letter to the Editor A 53-year-old woman with thrombocytosis and pulmonary embolism

Irrigation and Debridement

Irrigation and Debridement

A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center

PurposeThe use of intravascular devices is associated with a number of potential complications. Despite a number of evidence-based clinical guidelines in this area, there continues to be nursing practice discrepancies. This study aims to examine nursing practice in a cancer care setting to identify nursing practice and areas for improvement respective to best available evidence. MethodsA point prevalence survey was undertaken in a tertiary cancer care centre in Queensland, Australia. On a randomly selected day, four nurses assessed intravascular device related nursing practices and collected data using a standardized survey tool. Results58 inpatients (100%) were assessed. Forty-eight (83%) had a device in situ, comprising 14 Peripheral Intravenous Catheters (29.2%), 14 Peripherally Inserted Central Catheters (29.2%), 14 Hickman catheters (29.2%) and six Port-a-Caths (12.4%). Suboptimal outcomes such as incidences of local site complications, incorrect/inadequate documentation, lack of flushing orders, and unclean/non intact dressings were observed. ConclusionsThis study has highlighted a number of intravascular device related nursing practice discrepancies compared with current hospital policy. Education and other implementation strategies can be applied to improve nursing practice. Following education strategies, it will be valuable to repeat this survey on a regular basis to provide feedback to nursing staff and implement strategies to improve practice. More research is required to provide evidence to clinical practice with regards to intravascular device related consumables, flushing technique and protocols.

Sterilization Of Catheters Using Providone-Iodine Decreases The Incidence Of Catheter-Associated Bloodstream Infection

IntroductionThe use of central venous (CV) catheters is crucial for administering chemotherapy to children; however, catheter-related bacterial infections can be life threatening. The guidelines of Centers for Disease Control (CDC) and Prevention recommend ensuring sterile access to CV catheters by scrubbing the access port with an appropriate antiseptic, such as chlorhexidine, povidone-iodine, or 70% alcohol, and accessing the port only with sterile devices. For pediatric patients receiving chemotherapy, our institution uses the Hickman catheter as a CV catheter. Between April 2008 and March 2010, 83% alcohol was used to sterilize the access port. Because a large number of patients acquired subsequent infections including with Bacillus cereus, we used 10% povidone-iodine before accessing the catheter between April 2010 and March 2012. We compared the rates of bacterial infections during these two periods. Patients and MethodsWe performed blood cultures of patients receiving chemotherapy using venous puncture or a CV catheter before starting antibiotics. We determined the number of positive cultures, identified the infectious agent, and clinically evaluated the infected patients. Between April 2008 and March 2010, we investigated297 patients, of which 207 were treated using CV catheters. The median age of the 207 patients (129 males and 78 females) was 8 years (range, 2 months to 30 years). The indications for chemotherapy included stem-cell transplantation to treat the diseases as follows: hematological malignancies (n=127), malignant solid tumors (n=62), and congenital immune deficiencies (n=18). Between April 2010 and March 2012, we investigated 291 patients, of which 185 were treated using CV catheters. The median age of the 185 patients (129 males and 56 females) was 6 years (range, 10 months to 16 years). The indications for chemotherapy included the following conditions: hematological malignancies (n=98), malignant solid tumors (n=81), pure red-cell aplasia (n=4), and congenital immune deficiencies (n=2).We defined catheter-associated bloodstream infection by detection of common commensal pathogens, such as Staphylococcus species and Bacillus cereus, according to the definitions of the CDC/NHSN along with detection of pathogens from cultures collected from the access port of the CV catheter. ResultsThere was no significant difference between the two groups in patient characteristics such as median age and the period of neutropenia. The frequency of positive blood cultures were 16.4% (34/207) and 11.9% (22/185) (p = 0.224) for the former and latter periods, respectively. In the first period, 61.8% (21/34) of the pathogens isolated were gram-positive (e.g., S. epidermidis) and 41.2% (14/34) were gram-negative (e.g., B cereus). Our definition of catheter-associated bloodstream infection was met by 12.6% (26/207) in these cases. In the second period, 40.9% (9/22) of the pathogens isolated were gram-positive and 40.9% (9/23) were gram-negative (e.g., Enterobacter cloacae). Our definition of catheter-associated bloodstream infection was met by 6.5% (12/185) (p = 0.0658) Notably, B. cereus was not detected in the second period. ConclusionSterilization of the access port of CV catheters using povidone-iodine decreased catheter-associated bloodstream infection. A significant advantage of using povidone-iodine was eliminating infections with the fatal pathogen, B. cereus. Disclosures:No relevant conflicts of interest to declare.

Peripherally Inserted Central Catheter for Use in Home Parenteral Nutrition

Peripherally inserted central catheters (PICCs) are a relatively new device for home parenteral nutrition (HPN). Usually, tunneled central catheters such as the Hickman catheter are used for this purpose. However, severe complications (eg, pneumothorax) have been reported in association with the insertion of the central catheter. In contrast, PICCs may offer some advantages due to the peripheral insertion. There are only few studies on the use of PICCs for HPN. A retrospective study (2008-2012) was performed in our Center for Nutrition and Bowel Disease. Patients receiving parenteral nutrition through PICCs were identified, their files examined, and indication, dwell time, cause of removal, and complications recorded. Fifty-six patients (aged 28-81 years) had a total of 94 lines. Total catheter days were 9859. Mean catheter days per patient were 179.1, and mean dwell time of each line was 104.9 days (longest, 572 days). There were no major complications in relation to the insertion of the catheters. The catheters were removed due to catheter-related sepsis, mechanical reasons, and thrombotic complications in 1.7, 2.1, and 0.2 per 1000 catheter days, respectively. This study demonstrates that PICCs are appropriate for use in HPN for at least 3-4 months (a period that sometimes unexpectedly becomes long term). The complications equal those reported for tunneled central catheters. We conclude that PICCs are a relevant alternative to patients receiving HPN, especially if they cannot handle a central line. At present, the choice of catheter must be determined on an individual basis.

A retrospective study of central venous catheters GCRI experience

Background:The use of central venous catheters (CVCs) has greatly improved the quality-of-care in cancer patients, yet these catheters may cause serious infectious and thrombotic complications. The aim of this retrospective study was to study the various types of CVCs and their complications.Materials and Methods:We studied retrospectively 213 cases of CVCs in our institute with their indications, type and complications from August 2010 to July 2011.Results:A total of 213 CVCs were inserted in patients with hematological (62%) and solid organ malignancies (38%). Ninety-eight patients (46%) had peripheral inserted central catheter (PICC), 90 (42%) patients had Hickman catheters and 25 (12%) had a port. The median duration of retention of Hickman catheters was 104 days (3-365 days), for the peripherally inserted central catheters was 59 days (3-100 days) and for the port it was 280 days (45-365 days). Non-infective complications were more than infective (12% vs. 7%). The most common complication was non-infective occlusion and thrombophlebitis. In one patient with PICC thrombosis occurred in the cephalic, radial and ulnar vein and in one patient with port thrombosis occurred in the superior vena cava. Organisms were isolated in 60% (12 out of 20) of cultures. Common organisms isolated were Pseudomonas aeruginosa in 5 (42%), Staphylococcus aureus in 2 (16%), Escherichia coli in 2 (16%) and Aspergillus in 3 (25%) patients. 7 out of 12 infected patients had negative blood cultures within 7 days of antibiotic treatment, 5 patients remained positive for more than 7 days with antibiotics. In 155 patients (73%), the desired treatment protocol was completed and at present there are still 28 patients (13%) with catheters. 5 patients (2.3%) died of febrile neutropenia and septicemia with multi-organ failure. In 5 patients (2.3%), the catheters (1 Port, 1 Hickman and 3 PICC) were prematurely removed because of thrombosis.Conclusion:CVCs are better options to facilitate the long-term vascular access provided infection is prevented with meticulous care and treated promptly with proper antibiotics. Most CVCs is acceptable to patients.

Patency of neck veins following ultrasound-guided percutaneous Hickman line insertion

Venous occlusion following permanent central venous catheter (CVC) insertion by open cutdown or the landmark percutaneous technique has been reported between up to 25 %. However, there are no published data on the equivalent rate following ultrasound-guided percutaneous CVC insertion. The purpose of this study was to document the rate of venous occlusion associated with ultrasound-guided percutaneous CVC insertion in children. From 1 April 2010 to 1 December 2011, all children having elective or emergency removal of a Hickman line by the vascular access team had a Doppler ultrasound of their neck veins. Only Hickman lines inserted by the ultrasound-guided percutaneous route were included. Internal jugular, innominate and subclavian veins were scanned and recorded as patent, reduced or absent. We identified 100 consecutive children. Median age was 6 years (range 21 days to 16 years). Indication for insertion was chemotherapy (60), parenteral nutrition (15), blood products (12), renal replacement (3) and other indications (10). Three children had absent flow at the time of line removal (median age 4 months, range 3-6 months), with 2 out of 3 requiring removal for infection. The venous occlusion rate following ultrasound-guided insertion of CVC is 3 % in our study. We conclude that (1) complete venous occlusion is associated with younger age and CVC infection. (2) In our study, the venous occlusion rate of 3 % is significantly lower than the published series of either open cutdown or the landmark technique.

PP195-SUN THE EFFECT OF OSMOLARITY ON THE GROWTH OF E. COLI AND E. DURANS IN PARENTERAL NUTRITION CONTAINING LIPID

Rationale: The use of the femoral vein for parenteral nutrition (PN) is relatively contraindicated, because of common believe it’s associated with a high risk of contamination at the exit site at the groin, leading to sepsis and a high risk of venous thrombosis. When veins of upper part of the body became occluded, the femoral access is the first choice for long term PN, but such situation is now recognised as indication for intestinal transplantation. The aim was to evaluate safety of modified femoral venous access for HPN. Methods: 20 from 962 HPN patients suffered from intestinal failure presented complete occlusion of upper vena cava on admission (n = 8) or during HPN (n = 12 ), confirmed by phlebography and/or CT scan. 6.6 F Broviac catheter tunnelised to abdominal wall up for over 15 20 cm and then reversed, putting the cuff 5 cm down and exit site 2 cm lower, was inserted under fluoroscopy through femoral vein into right atrium. Exit site infection and central catheter related blood stream infection (CRBSI) rate was retrospectively analysed and compared with observed in the same patients when tunnelised upper vein access was used before occlusion of upper veins or after theirs recanalization. Results: HPN was provided for total of 31 206 days through femoral and 20422 days through subclavian or jugular vein. The CRBSI rate was 1.66/1000 HPN days for upper access and 0.27/1000 HPN days for femoral vein and exit site infection 0.09/1000 HPN days for both. Thrombosis of both femoral veins has occurred in 2 patients, upper veins recanalised after 3 12 years in 4 patients. Conclusion: Modified femoral access is safe. The risk of thrombosis is low with systemic anticoagulation. The reason for lower complications rate may be due to better catheter care performance with growing experience but also due to easier handling by the patients.

Kocuria kristinae: A true pathogen in pediatric patients

Kocuria kristinae is a Gram-positive microorganism, which has rarely been reported as a pathogen that causes infection in humans. Recently, a few studies had concluded that this pathogen can indeed cause infection in immunocompromised hosts. However, the number of reports on K. kristinae infection in pediatric patients is still relatively limited. Clinical data on pediatric patients who had K. kristinae cells isolated from their blood specimens during the period from January 2008 to May 2012 in a tertiary-care hospital in northern Taiwan were gathered and analyzed. Among 12 patients with K. kristinae cells isolated from their blood specimens, laboratory test results confirmed seven to have K. kristinae bloodstream infection. Six of them were premature babies, and one had acute leukemia. The infections were all healthcare associated. All the six premature babies had clinical presentation of sepsis and were inserted with percutaneous central venous catheters. One patient had two sets of blood culture positive for K. kristinae infection, and two premature patients had two sets of K. kristinae isolated, one from blood culture and the other from catheter tip culture, both of which were done at the same time. The leukemic child was inserted with a Broviac catheter and had K. kristinae isolated from both blood specimen and Broviac catheter. In the remaining five patients, K. kristinae infection was considered to be contaminant because they had only one set of positive blood culture and had other recognized infections. K. kristinae can cause infections in premature babies and immunocompromised pediatric patients using long-term intravenous catheters. Therefore, K. kristinae should be considered as a true pathogen and proper treatment should be provided to all susceptible pediatric patients.

Spectrum of external catheter-related infections in children with acute leukemia—Single-center experience

External catheters (ECs) are commonly used in children who are receiving treatment for acute leukemia. To study the spectrum of microorganisms and to compare the rates of infection. A total of 42 ECs were inserted, including 28 Port-A-Caths, 11 CVC lines and 3 Hickman lines. Single ECs were required for 19 patients (45.2%), whereas 2, 3 and 4 ECs were required in 8, 1 and 1 patients, respectively. Overall, 37 culture-documented infections were present in 18 (62%) patients who had ECs. Gram-positive microorganisms were identified in 20 cases, Gram-negative microorganisms in 14 cases and fungal infections in 3 cases. Of the 42 devices implanted, 10 out of 28 Port-A-Caths (35.7%), 2 out of 3 Hickman catheters (66.7%) and 9 out of 11 central venous catheters (81.8%) required removal due to infection. The average length of working life for the ports was 330.6 days (range: 40-1043 days). The median rate of complications due to infection was 2.84 infections per 1000 catheter days (interquartile range: -1.55 to 5.8), and the number of infections was correlated with the number of ports (Pearson's r=0.51; p<0.05).