Catheter Management Across Patients with Hematologic Malignancies and Catheter-Related Blood Stream Infections: A Systematic Review
CCCF ePoster library. Heybati K. 11/13/19; 283391; EP122
Kiyan Heybati
Kiyan Heybati
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Abstract
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ePoster
Topic: Systematic Review, Meta-Analysis, or Meta-Synthesis

Heybati, Kiyan1; Piticaru, Joshua2; Ahluwalia, Nanki3; Munshi, Laveena4; Thyagu, Santhosh 5

1Health Sciences, McMaster University, Hamilton, Canada; 2Division of General Internal Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Canada;  3Department of Medicine, Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, Toronto, Canada; 4Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada; 5Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada


Background: Long-term central venous catheters (CVC) are commonly used in patients with

haematological malignancies (HM). Catheter-related bloodstream infection (CRBSI) leading to

sepsis is one of the common indications for admission to the intensive care unit. Such patients

with CRBSI often have co-existing thromobocytopenia, coagulopathy or need for ongoing access,

leading to reservation surrounding catheter removal. Despite clinical guidelines for the

management of CRBSI suggesting catheter removal in the general population, variability exists

in the management of catheters in the setting of CRBSI for HM patients. It remains unclear

whether CVCs can be safely retained or whether removal should be pursued across all cases.

Objectives: The main objective of the systematic review was to identify the current state of the

evidence on CVC management in HM patients with suspected or confirmed uncomplicated

CRBSI. We aimed to characterize catheter management in the setting of uncomplicated CRBSI

and evaluate whether there is an association with patient outcomes and adverse events related to

catheter management.

Methods: We conducted a review of randomized controlled trials and observational studies of

adult patients with HM who developed CRBSI. Studies that evaluated staphylococcus aureus,

fungemia, and complicated bacteremias (ie infective endocarditis) were excluded. The following

databases were searched from inception through June 2019: Ovid MEDLINE,Ovid Embase,

Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Clinical

Trials, and CINAHL. Our primary outcome was infection recurrence. Our secondary outcome

was 30-day mortality.

Findings: Twenty studies with a total of 2,006 patients were included in our review of which 1

was a randomized controlled trial and 19 were observational studies. Studies demonstrated clinical

heterogeneity and therefore we restricted our study to a systematic review without metaanalysis.

Catheters were removed in 1347 (67%) patients and retained in 659 (33%) patients.

Median age was 49.7 (IQR 43-55), acute myeloid leukaemia (AML) was the most common HM,

and median time to the developed of CRBSI was 19 days (IQR 11.5-74.5). Gram positive bacteremias,

and specifically coagulase negative staphylococcus aureus, were the predominant organisms

responsible for the CRBSI (catheters removed 75%, catheters retained 68%). Seven

studies reported on infection recurrence, with a 4% (IQR 1.5–10.3) rate of recurrence across patients

who had their catheters removed compared to 7% (IQR 0-62.2) across those who had their

CVC left in situ. Median thirty-day mortality was 7% (IQR 4.2-25.6) across the cohort that had

their catheter removal compared to 44% (IQR 12.5-45.3) across the cohort with their catheter

retained. Studies were predominantly fair quality evaluated based upon the Newcastle Ottawa

Scale.

Conclusions: There exists a paucity of high quality data surrounding catheter management for

CRBSI across HM patients. In our exploratory analysis, catheters were retained in up to 1/3 of

HM patients with CRBSI. Our study suggests that catheter retention may be associated with a

higher risk of infection recurrence and mortality; however, this was not adjusted for potentially

important confounders. Given the increasing volume of HM patients presenting to the ICU, future

research needs to address catheter management in this population along with potential harms

associated with catheter retention.


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