Calderón-Elvir C, Arias R, De Colsa-Ranero A, Gutiérrez-Castrejón P, Almazán-Bonora G

Language: Spanish
References: 33
Page: 27-39
PDF size: 599.57 Kb.

ABSTRACT

Antecedents: The two main complications of the long-term catheter use are infection and thrombosis. Several studies have demonstrated that the infection rates in completely implanted port are a lot but it lowers that for the catheters Hickman/Broviac. The factors of risk for the adherence of the micro-organism to the surface of the catheter depend on the following factors: the guest, the microbial factors, the material of the catheter and the use to that it is subjected the catheter. The predominant micro-organisms in general causing of infections related to catheter they are the coagulase-negative staphylococcus, however, the proportion of infections related to catheter caused by gram negative bacilli is higher in children with cancer in 32-48%.
Objectives: 1. to know the bacterial epidemiology in the catheter related infections of long-therm catheter in children with cancer 2. To Determine the risk factors associate to develop infection of long-term catheter.
Material and methods: The clinical files of 300 children with cancer were revised to who were placed a long-term catheter of the type implantable venous access system, Broviac-Hickman or Quinton, during the period of January de1995 to December of the 2003, they were formed 2 groups for their study: the patients with related infection, and those that did not present infectious process during the stay of the catheter.
Results: During the period of study there were 51 infectious processes related to the catheter to permanency, 50% of the type Broviac-Hickman, 50% those of type Quinton, 16.2% of the type implantable port, x2 4.94,p 0.85. Infection rate related to catheter per 1000 device-days , being in 1995 3.9 while it stops 2003 diminish at 0.39, risk factors were age: mean 53.37 months, std. deviation 51.98 months, t of Student 3.94, p 0.000, IC 95% (17.12-50.39), type of solid tumor 21.1%, leukemias 10.8%, x2 5.39, p 0.020, when the indication of the placement was for transfusion 100% relates to infectious process, following transplant of marrow 33.3% and chemotherapy 16.2%, x2 6.71, p 0.035. 43.1% of the infections was for pathogen gram negative, 39.3% for gram positive and 17.6% for fungus. The clinical manifestation more frequents was bacteraemia 68.6%, fever without focus 52.9%, infection of the place 21.6%, cellulitis 13.7%, abscess 5.9%, tunelitis 3.9% and endocarditis 3.9%.
Discussion: The rate of infectious processes related to catheter has diminished considerably, the factors of risk were the age, prevailing in younger than 5 years, the tumour type being the most frequent the solid tumour, the indication of the placement presenting more infection risk the transfusion, as well as the catheter type being the type Broviac-Hickman that of more infection risk. Gram negative was isolated with more frequency 43.1%, gram positive 39.3% and fungus in 17.6%.

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