Get access

No evidence of benefit from antibiotic lock therapy in pediatric oncology patients with central line-related bloodstream infection: Results of a retrospective matched cohort study and review of the literature

Authors

  • Joshua Wolf BA, MBBS, FRACP,

    Corresponding author
    1. Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
    2. University of Tennessee Health Sciences Center, Memphis, Tennessee
    3. Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
    • Correspondence to: Joshua Wolf, Department of Infectious Diseases, St Jude Children's Research Hospital, 262 Danny Thomas Pl, MS 320, Memphis, TN 38105.

      E-mail: joshua.wolf@stjude.org

    Search for more papers by this author
  • Kim J. Allison BSN,

    1. Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
    Search for more papers by this author
  • Li Tang PhD,

    1. Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
    Search for more papers by this author
  • Yilun Sun MS,

    1. Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
    Search for more papers by this author
  • Randall T. Hayden MD,

    1. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
    Search for more papers by this author
  • Patricia M. Flynn MD, MS

    1. Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
    2. University of Tennessee Health Sciences Center, Memphis, Tennessee
    Search for more papers by this author

  • All authors have no conflicts of interest with respect to this manuscript.

Abstract

Background

Long-term central venous catheters (CVCs) are essential to modern pediatric oncology practice, but central line-related bloodstream infection (CRBSI) is a frequent and important complication. CVC salvage is often attempted but treatment failure is common due to persistent infection, delayed catheter removal, or subsequent relapse of infection, which can be associated with significant morbidity and cost. Adjunctive antibiotic lock therapy (ALT) has been proposed to reduce the risk of treatment failure, but insufficient data are available to confirm efficacy of this intervention.

Procedure

We undertook a retrospective matched cohort study of ALT use for treatment of CRBSI in pediatric hematology/oncology patients at St. Jude Children's Research Hospital between 2006 and 2012.

Results

Thirty-eight eligible episodes of CRBSI treated with adjunctive ALT were identified and compared to 73 episodes treated with standard therapy (ST) alone, matched by catheter-type and organism. Overall, treatment failure was similar between ALT and ST groups (50.0 vs. 38.4%; P = 0.24), but the timing was different; in the ALT cohort, immediate CVC removal was less common (0.0 vs. 12.3%; P = 0.03) but delayed removal (4–13 days) and relapse of infection was more common (50.0 vs. 24.7%; P = 0.01).

Conclusions

This retrospective study was unable to identify any benefit of adjunctive ALT in pediatric oncology patients with CRBSI. The available evidence does not support routine ALT use, and well-conducted prospective studies are needed. Pediatr Blood Cancer 2014; 61:1811–1815. © 2014 Wiley Periodicals, Inc.

Ancillary