Use of central venous catheters in haematological patients and associated infections: overview of the situation in the Czech and Slovak Republics and recommendations for prevention and diagnosis
Abstract
Central venous catheters are routinely used as a venous access in haematological patients requiring intensive care or parenteral chemotherapy. Despite its many benefits, the use of central venous catheters can be associated with several complications.
The most serious and most common complications are catheter related bloodstream infections that significantly increase morbidity and mortality of patients with haematological malignancy. On behalf of the Czech leukaemia group for Life (CELL), a retrospective analysis of the use of central venous catheters and the results of microbiological examination of extracted central venous catheters at haematological centres in Czech Republic and Slovakia was performed.
A short questionnaire was used for this purpose. Data from 2015 from 7 adult and 4 paediatric centres were evaluated.
A total of 3195 central venous catheters were inserted in the centres involved, whereby short-term catheters were used 4 times more often than long-term catheters. The preferred subtype of short-term catheter according to the site of insertion were catheters inserted via the subclavian vein (49.7%), however there were significant differences between centres.
On average - 45% of the extracted catheters were sent for microbiological examination. A significantly higher proportion of catheters were thus examined in paediatric centres compared to adult centres (65.3% vs. 33.5%).
Positive culture results were found on average in 20 % catheters examined microbiologically. Most frequently, catheter tip cultures involved gram positive cocci, mostly coagulase negative staphylococci and Staphylococcus aureus.
When coagulase negative staphylococci were excluded, gram negative bacteria namely Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae, were the most prevalent findings. No significant differences were found in Czech and Slovak haematological centres when compare to international data and recommendations.
Nevertheless, significant differences between individual centres were observed and thus we believe that more strict compliance with current international recommendations for the prevention and diagnosis of catheter related infections is required. These guidelines are also part of this manuscript.