Divisions of Pediatric Infectious Diseases, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.
Pediatric Hematology and Oncology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.
Turk J Pediatr. 2021;63(1):86-94. doi: 10.24953/turkjped.2021.01.010.
Catheter-related bloodstream infection (CRBSI) is one of the most common complications of central lines. Data concerning the effectiveness and safety of antibiotic lock therapy (ALT), especially in pediatric hematology and oncology patients, have not yet reached sufficient levels of evidence. We aimed to share our center`s experience on ALT in pediatric cancer and to investigate the causes of ALT failure.
All cases with CRBSI and treated with ALT administiration in children with cancer between January 2015 and May 2019 were reviewed. Patients characteristics, laboratory and clinical findings, treatments, outcome of ALT, recurrences and reinfections were recorded. Patients with successful and unsuccessful ALT outcomes were compared in order to identify the risk factors for ALT failure.
Sixteen eligible CRBSI treated with adjunctive ALT were identified. The most common pathogens were coagulase negative staphylococci (8/16, 50%). Treatment failure was observed in 31.2% (5/16). Younger age alone was an independent risk factor for treatment failure (0.9 vs 6.8 years, p = 0.038). Recurrence and reinfection rates were 23.1% and 16.7%. Mild bleeding occured in two cases (12.5%) and occlusion causing catheter removal was seen in one (6.3%).
ALT was found to be a safe modality with a success rate of 68.8% in children with cancer at our center and younger age was an independent risk factor for treatment failure. Future studies with larger sample sizes are needed to determine the factors affecting the ALT outcome, especially in childhood malignancies.
导管相关血流感染（CRBSI）是中心静脉置管最常见的并发症之一。关于抗生素锁治疗（ALT）的有效性和安全性的数据，特别是在儿科血液学和肿瘤学患者中，尚未达到足够的证据水平。我们旨在分享我们中心在儿科癌症中使用 ALT 的经验，并探讨 ALT 失败的原因。
回顾 2015 年 1 月至 2019 年 5 月期间接受 ALT 治疗的所有患有 CRBSI 的癌症患儿。记录患者特征、实验室和临床发现、治疗、ALT 结果、复发和再感染。比较 ALT 结果成功和失败的患者，以确定 ALT 失败的危险因素。
确定了 16 例符合条件的接受辅助 ALT 治疗的 CRBSI 患儿。最常见的病原体是凝固酶阴性葡萄球菌（8/16，50%）。治疗失败的发生率为 31.2%（5/16）。仅年龄较小是治疗失败的独立危险因素（0.9 岁 vs 6.8 岁，p=0.038）。复发和再感染率分别为 23.1%和 16.7%。有 2 例（12.5%）发生轻度出血，1 例（6.3%）因闭塞导致导管移除。
在我们中心，ALT 被发现是一种安全的方法，成功率为 68.8%，在儿童癌症患者中，年龄较小是治疗失败的独立危险因素。需要更大样本量的未来研究来确定影响 ALT 结果的因素，特别是在儿童恶性肿瘤中。
