Outcomes of Hickman catheter salvage in febrile neutropenic cancer patients with Staphylococcus aureus bacteremia.

OBJECTIVE

To evaluate the outcome of attempted Hickman catheter salvage in neutropenic cancer patients with Staphylococcus aureus bacteremia who were not using antibiotic lock therapy.

DESIGN

Retrospective cohort study.

SETTING

A university-affiliated, tertiary-care hospital with 1,500 beds for adult patients.

PATIENTS

All neutropenic cancer patients who had a Hickman catheter and S. aureus bacteremia (32 episodes in 29 patients) between January 1998 and March 2002.

METHODS

Salvage attempts were defined as cases where the Hickman catheter was not removed until we obtained the results of follow-up blood cultures performed 48 to 72 hours after starting treatment with antistaphylococcal antibiotics. Salvage was considered to be successful if the Hickman catheter was still in place 3 months later without recurrent bacteremia or death.

RESULTS

Catheter salvage was attempted in 24 (75%) of the 32 episodes. Of the salvage attempts, the success rate was 50% (12 of 24). Salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures, and in 65% (11 of 17) of those with negative follow-up blood cultures (P = .07). If the analysis is confined to cases with no external signs of catheter infection, salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures and in 80% (8 of 10) of those with negative follow-up blood cultures (P = .02).

CONCLUSION

In neutropenic cancer patients with S. aureus bacteremia, attempted catheter salvage without antibiotic lock therapy was successful in 50% of the cases.