Central venous catheter-associated bloodstream infections in pediatric hematology-oncology patients and effectiveness of antimicrobial lock therapy

J Microbiol Immunol Infect. 2015 Dec;48(6):639-46. doi: 10.1016/j.jmii.2014.07.008. Epub 2014 Oct 11.


Background: Central line-associated bloodstream infection (CLABSI) is a serious complication in hematology-oncology patients. This study aimed to analyze the prevalence of CLABSI and the effectiveness of antimicrobial lock therapy (ALT) in pediatric patients.

Methods: BSIs of all pediatric hematology-oncology patients admitted to a children's hospital between January 2009 and December 2013 were reviewed. The United States National Healthcare Safety Network and Infectious Diseases Society of America guidelines were used to define CLABSI and catheter-related BSI (CRBSI). The incidence, laboratory and microbiology characteristics, poor outcome, and effectiveness of ALT were analyzed.

Results: There were 246 cases of CLABSI in 146 patients (mean age, 10.0 years), including 66 (26.8%) cases of CRBSI. The incidence of CLABSI was 4.49/1000 catheter-days, and the infection was responsible for 32.9% of the complications these patients developed and 9.3% of contributable mortality. Patients with acute myeloid leukemia had the highest infection density (5.36/1000 patient-days). Enterobacteriaceae (40.2%) and coagulase-negative staphylococci (CoNS; 20.7%) were the predominant pathogens. In multivariate analysis, older age, male sex, elevated C-reactive protein, acute lymphoblastic leukemia, and candidemia were associated with poor outcome. The success rate of ALT was 58.6% (17/29) for the treatment of CoNS and 78.3% (29/37) for Enterobacteriaceae infections. Patients with candidemia (n = 18) had the highest mortality (33.4%) and catheter removal rate (66.7%). Chlorhexidine as the disinfectant decreased the 1-year CLABSI rate from 13.7/1000 to 8.4/1000 catheter-days (p = 0.02).

Conclusion: CoNS and Enterobacteriaceae are the predominant pathogens in CLABSI among pediatric hematology-oncology patients. ALT is effective and showed no significant side effect. New disinfection practice and infection control measures can decrease CLABSI.

Keywords: antimicrobial lock therapy; bloodstream infection; central catheter; hematology–oncology; pediatric.

MeSH terms

  • Adolescent
  • Anti-Infective Agents / therapeutic use
  • Bacteremia / drug therapy
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • C-Reactive Protein / metabolism
  • Candidemia / epidemiology
  • Candidemia / microbiology
  • Catheter-Related Infections / drug therapy
  • Catheter-Related Infections / epidemiology*
  • Catheter-Related Infections / microbiology
  • Catheterization, Central Venous / adverse effects*
  • Central Venous Catheters / microbiology*
  • Child
  • Child, Preschool
  • Chlorhexidine / pharmacology
  • Disinfectants / pharmacology
  • Enterobacteriaceae / isolation & purification
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / microbiology
  • Female
  • Humans
  • Infection Control
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology
  • Staphylococcus / isolation & purification


  • Anti-Infective Agents
  • Disinfectants
  • C-Reactive Protein
  • Chlorhexidine