2006, Number 3
Microorganisms isolited from neutropenic pediatric patients with vascular devices and their clinical evolution
Full text
Language: Spanish
References: 12
Page: 66-71
PDF size: 81.80 Kb.
ABSTRACT
Objectives. To determine the frequency of microorganisms isolated from blood cultures obtained through central venous catheters (CVC), in patients with neutropenia and fever, and describe the clinical outcome according to the antimicrobial treatment.Patients and methods. Retrospective study performed in a tertiary care level pediatric center in Mexico City. From all the blood cultures processed in the clinical laboratory, from January to December 2002, 32 were selected corresponding to samples taken through CVC from hemato-oncologic patients with fever and neutropenia. Frequencies according to species were registered and the clinical outcome in response to the antimicrobial treatment, withdrawal of the catheter, type of bacteria isolated and susceptibility profile was evaluated.
Results. Thirty-two positive blood cultures obtained through CVC from 29 patients were included. Clinical files were analyzed. The microorganisms more frequently isolated were gram-negative bacilli (72%), of them Klebsiella sp in 22%. Of the gram-positive bacteria, coagulase-negative Staphylococcus predominated (15.6%). In 62% of the patients, the defervescense of fever occurred in the first 72 h of treatment, scarcely more prolonged in patients with gram-negative bacteremia. In 72% of the patients that received broad-spectrum empirical treatment fever disappeared in the first 72 h, while in patients with an scheme restricted to gram-positive cocci, fever remitted in only 27%.
Conclusions. Gram-negative bacilli were the most frequent microorganisms isolated from blood cultures taken through CVC in patients with fever and neutropenia. Best outcome was observed in patients that received a broadspectrum antimicrobial therapy.
REFERENCES
Chambers S, Sanders J, Patton W, Ganly P, Birch M, Crump J, Spearing R. Reduction of exit-site infections of tunneled intravascular catheters among neutropenic patients by sustained-release cholrhexidine dressings: results from a prospective randomized controlled trial. J Hosp Infect 2005; 61: 53-61
Jaeger K, Zenz S, Juttner B, Ruschulte H, Kuse E, Heine J, Piepenbrock S, Ganser A, Karthaus M. Reduction of catheter-related infections in neutropenic patients: a prospective controlled randomized trial using a chlorhexidine and silver sulfadiazine-impregnated central venous catheter. Ann Hematol. 2005;84:258-62