Hydrochloric acid treatment of tunneled central venous catheter infections in children with cancer.

BACKGROUND: Long-term tunneled central venous catheters (CVCs) are often the source of catheter-associated bloodstream infections (CABSIs), which may be difficult to eradicate and may lead to premature catheter removal. PROCEDURE: This prospective controlled study used instillation of 2 M hydrochloric acid (HCl) as an adjuvant to the intravenous antibiotic treatment of children with bacteremia and compared the results with those from the immediate preceding period. The primary outcome variable was infection-related CVC removal within 100 days of bacteremia. Only patients with double lumen Hickman CVC with external tubings were included. RESULTS: During a period of 36 months, 109 episodes of bacteremia were treated, 51 during the period where HCl was not used and 58 during the period where HCl was used. Forty-two out of 58 bacteremias were treated with HCl during the "HCl period." An intention-to-treat analysis showed that the median time to infection-related CVC removal was significantly longer during the HCl period compared with the non-HCl period (94 d vs. 12.5 d). At day 100 significantly more CVCs remained in place compared with the non-HCl period. Of the 42 CVCs treated with HCl, 2 had to be removed because of infection before day 30 and further 7 CVCs were removed before day 100. There was no difference in the occurrence of new bacteremias within the first 30 days of bacteremia in the 2 groups. CONCLUSION: HCl may successfully supplement intravenous antibiotics in the treatment of CABSI and contribute to CVC salvage.

Infections during induction therapy for children with acute lymphoblastic leukemia. the role of sulfamethoxazole-trimethoprim (SMX-TMP) prophylaxis.

BACKGROUND: Bacteremias are frequent during induction therapy for acute lymphoblastic leukemia (ALL) in children. Antibacterial prophylaxis therapy may thus be warranted. The purpose of this study was to analyze the rate of infections during induction therapy in two cohorts of children with ALL where one cohort received prophylactic sulfamethoxazole-trimethoprim (SMX-TMP). PROCEDURE: All infections were registered through a retrospective non-randomized review of medical records of 171 consecutive children newly diagnosed with ALL below 15 years of age at diagnosis. A total of 85 children treated from 1992 to 2000 did not receive SMX-TMP, whereas 86 children treated from 2000 to 2008 received SMX-TMP 20 mg/kg in one daily oral dose during induction therapy. RESULTS: A total of 26% of all children had no febrile episodes during induction. Infections were more frequent in children below 5 years of age. Significantly fewer children receiving SMX-TMP developed fever (17% vs. 34%, P = 0.02) and bacteremia (20% vs. 45%, P = 0.0003). Especially children with non-high risk criteria had fewer infections when receiving prophylaxis. When adjusting for age, type of catheter, and SMX-TMP prophylaxis on the risk of bacteremia by a multiple Cox regression analysis, we found that age and prophylaxis, but not the type of catheter, were associated with a significantly reduced risk of bacteremia. CONCLUSION: Children with ALL receiving SMX-TMP prophylaxis during induction therapy experienced fewer febrile episodes, fewer days with fever demanding intravenous antibiotic treatment, and fewer episodes of bacteremia. Both SMX-TMP prophylaxis and age played significant independent roles for the occurrence of bacteremia.

[Tunnelled central venous catheters in children with cancer. Removal and duration]. / Tunnelerede centrale venekatetre til børn med cancer. Arsager til fjernelse og katetervarighed.

INTRODUCTION: Most children with cancer have a tunnelled central venous catheter (CVC) inserted. The optimal type of CVC for children of all ages has not been identified. The purpose of this paper was to analyze factors correlated to the duration of catheterization of the first inserted CVC in children with cancer. MATERIALS AND METHODS: All children with cancer who had their first CVC inserted between 01-01-2000 and 01-09-2006. Retrospective and prospective study of medical charts with respect to the type of CVC, age of the child at insertion, dates of insertion and removal, diagnosis and cause of CVC removal. RESULTS: Between 01-01-2000 and 01-09-2006 155 double lumen Hickmans (2-Hick) and 86 double lumen Port-a-Caths (2-PaC) were inserted. The total number of CVC days was 27,192 for 2-Hicks and 20,623 for 2-PaCs. The median duration of catherization was significantly longer for 2-PaCs compared with 2-Hicks (200 versus 135 days). Compared with 2-PaCs significantly more 2-Hicks were removed non-electively because of either infections or mechanical complications. The survival of 2-Hicks was significantly shorter in children <5 years of age, but for 2-PaCs there were no correlation between the duration of catherization and the age of the child. 67% of the 2-PaCs were removed at the end of treatment compared with 32% of the 2-Hicks (P< 0,001, chi2 test). A multivariate analysis showed that the type of CVC (P<0,001) and the age of the child (P< 0,001) were independent factors for the duration of the catheterization. CONCLUSION: Port-a-Caths for children of all ages with cancer are associated with significantly fewer catheter removals due to complications.