Diagnostic difficulties in catheter-related infections in children with neoplastic diseases

Background. Central venous catheters (CVC) are very useful devices in modern-day oncology. They are indispensable to administer drugs, blood products, intravenously nutrition, but they put patients at risk for local and systemic infectious and other complications. Material and methods. The authors analyzed retrospectively 309 blood cultures obtained from 124 children with fever suffering from neoplastic diseases (leucemias, lymphomas, Wilms tumors). The children aged 1-17 year were admitted to the hospital between October 2007 and February 2008. The majority of them (85%) had Broviac catheter. Only in 15% cases the port-a-cath was placed. Analysis was based on bacteriological blood inoculation, inflammatory markers and clinical signs of infection. Results. There are obtained only 26 positive blood cultures. In 23% of them (6/26) the bacteria were found only in CVC, in 35% the same positive blood culture were found in CVC and in the blood stream and in 42% (11/26) bacteria were isolated only from the blood stream. There were 57% of Gram(-) positive bacteria. The most frequent pathogens were: S. epidermidis - 23%, E. coli ESBL(-) - 15% and Salmonella type D - 12%. Younger children (< 5 yr) had higher rate of infection. 6 catheters were removed. Conclusions. 1. Positive blood cultures are very seldom in children with fever suffering from cancer. 2. Gram positive bacteria are the most common cause of CVC related infections. 3. Younger children (< 5 yr) had higher rate of positive blood cultures in CVC related infections.