Central LINE-Associated Blood STREAM INFECTIONS In PATIENTS with Hematological Malignancies AN EXPERIENCE FROM Qatar

Central-line access is an important part of healthcare practice especially for patients with hematological malignancies; however,central line-associated blood stream infection (CLABSIs) are important and deadly Health- care–associated infections (HAIs) and they are considered as a major problem that causes significant morbidity and mortality, and excess length of stay and cost. The risk of infection depends on, the site of insertion, the type of device, the underlying co morbidity and the appropriate prevention measures taken during insertion. Management of central line-associated bloodstream infections involves deciding on the type and duration of systemic antimicrobial therapy and catheter removal, antibiotic lock therapy. Systemic antimicrobial use is essential but, although generally effective in controlling sepsis, it often fails to sterilize the line, increasing the incidence of complications or recurrence. The decision regarding whether the catheter should be removed or retained is therefore crucial. One of the major factors to be considered is the type of organism involved in the line-related infection.

to evaluate the central Line-associated blood stream infections in patients with hematological malignancies in Al-Amal Hospital, (inpatient wards, outpatient day care unit) and among patients transferred to intensive-care units.

we evaluated central Line-associated blood stream infections in patients with hematological malignancies admitted to Al-Amal Hospital in Qatar between February 2007-December 2010. Strict protocol for febrile neutropenia is followed with proper timely intervention. Systematic review for all blood stream infections were done by nursing infection control practitioners, hematologists, microbiologists following the definitions of CDC-NHSN.

39 events were evaluated, 25 (64%) events in patients with AML, 10 (26%) events with ALL, 2 (5%) events with CLL, 1 (2.5%) event with CML and 1 (2.5%) event with NHL. Males were 25 and females were 14, with male to female ratio 1.8:1. The age range from 19 to 69 year with mean age group of 42 year. The most common infections were Gram negative organisms (27events), and among the gram negative organisms pseudomonas was the commonest infection (7 events), with 4 of them died, MDR reported in 6 events among the gram negative infections.

Fungal infections were 9 events (6 Candida and 3 Aspergillus) with one death due to Candida tropicalis, the least common infections were Gram positive organisms, 3 events were recorded with one mortality due to staph. hemoliticus. Overall mortality was 9 out of 39 (23%).

most of the infections occurred in non-tunneled catheters, and then tunneled catheters, rarely with port-A-Catheter. Based on the isolates the mortality was higher among patients with gram negative which is expected in such category of patients, and despite high number of fungal infections the mortality rate was low in affected patients (due to timely intervention with removal of line and proper use of anti-fungal ). Continued success in CLABSI prevention will require increased adherence to current CLABSI prevention recommendations, development and implementation of additional prevention strategies, and the ongoing collection and analysis of data, including specific microbiological informations.

No relevant conflicts of interest to declare.