Central venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients

Authors

  • Maha Boktour M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Hend Hanna M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Shoaib Ansari M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Boulos Bahna M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Ray Hachem M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Jeffrey Tarrand M.D.,

    1. Department of Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Kenneth Rolston M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Amar Safdar M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Issam Raad M.D.

    Corresponding author
    1. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, University of Texas M. D. Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402
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    • Fax: (713) 792-8233


  • An abstract based on this article was presented at the 42nd Annual Meeting of the Infectious Diseases Society of America (IDSA), Boston, Massachusetts, September 30–October 3, 2004.

Abstract

BACKGROUND

Stenotrophomonas maltophilia bacteremia is frequently found in cancer patients. This study attempted to determine how often the catheters were the source of this infection and the risk factors associated with catheter-related bacteremias.

METHODS

The microbiology records were retrospectively reviewed of all cancer patients having S. maltophilia bacteremia and indwelling central venous catheters seen between January 1998 and January 2004. In a multivariate analysis the patients' clinical characteristics, antimicrobial therapy, outcome, and source of bacteremia that were significantly associated with definite catheter-related S. maltophilia bacteremia as opposed to secondary bacteremia were identified.

RESULTS

A total of 217 bacteremias were identified in 207 patients: 159 (73%) were primary catheter-related (53 definite, 89 probable, and 17 possible), 11 (5%) were primary noncatheter-related, and 47 (22%) were secondary. Multivariate analysis showed the following factors to be independently associated with definite catheter-related bacteremias: 1) polymicrobial bacteremia (odds ratio [OR], 7.6; 95% confidence interval [95% CI], 1.3–45.5); 2) no prior intensive care unit admission (OR, 0.06; 95% CI, 0.005–0.578); and 3) nonneutropenic status at onset (OR, 0.07; 95% CI, 0.013–0.419). The response rate to appropriate antibiotics and catheter removal was 95% in the patients with definite catheter-related bloodstream infections, compared with only 56% in the patients with secondary bacteremias (P = .001).

CONCLUSIONS

The majority of the S. maltophilia bacteremias occurring in cancer patients with indwelling central venous catheters appear to be catheter-related and are often polymicrobial. Catheter-related S. maltophilia bacteremias occurred more frequently in noncritically ill, nonneutropenic patients, and prompt removal of the catheter was found to be associated with a better prognosis. Cancer 2006. © 2006 American Cancer Society.

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