Indwelling-tunneled-central-venous-catheter-related early bacteremia and preoperative prophylaxis: a case and control study.

I Planas Díaz, M Molina Mata, I Casal Beloy, R Cabello Laureano
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Abstract

Introduction: The indication of preoperative prophylaxis in the insertion of indwelling tunneled central venous catheters (ITCVC) has a low level of evidence. Our objective was to assess risk factors of ITCVC-related early bacteremia in oncological pediatric patients and to determine the need for preoperative prophylaxis.

Materials and methods: A univariate and multivariate retrospective analysis of patients in whom an ITCVC was placed from January 2020 to July 2023, according to whether they had ITCVC-related early bacteremia (EB) in the first 30 postoperative days, was carried out. Demographic variables, leukopenia, neutropenia, use of preoperative antibiotic prophylaxis, and history of central venous catheter (CVC) or bacteremia were collected. Calculations were carried out using the IBM SSPS29® software.

Results: 176 patients with a mean age of 7.6 years (SD: 4.82) were analyzed. 7 EB cases were identified, with a greater frequency of neutropenia (p= 0.2), history of CVC in the 48 hours before insertion (p= 0.08), and intraoperative CVC (p= 0.04). The presence of intraoperative CVC increased the risk of EB 9-fold [OR: 9.4 (95%CI: 1.288-69.712) (p= 0.027)]. The lack of preoperative prophylaxis did not increase the risk of EB [OR: 2.2 (CI: 0.383-12.669) (p= 0.3)]. The association with other variables was not significant.

Conclusions: The intraoperative presence of CVC was a risk factor of EB in our patients. Preoperative prophylaxis had no impact on the risk of EB, which in our view does not support its use. However, further studies with a larger sample size are required. Leukopenia or neutropenia at diagnosis were not associated with a greater prevalence of infection.

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与留置导管相关的早期菌血症和术前预防:一项病例和对照研究。
导言:植入留置隧道式中心静脉导管(ITCVC)的术前预防指征的证据水平较低。我们的目的是评估肿瘤儿科患者发生与ITCVC相关的早期菌血症的风险因素,并确定术前预防的必要性:我们对2020年1月至2023年7月期间置入ITCVC的患者进行了单变量和多变量回顾性分析,根据他们在术后前30天内是否出现ITCVC相关早期菌血症(EB)进行了分析。收集了人口统计学变量、白细胞减少症、中性粒细胞减少症、术前抗生素预防使用情况以及中心静脉导管(CVC)或菌血症病史。使用 IBM SSPS29® 软件进行计算:分析了 176 名患者,平均年龄为 7.6 岁(标清:4.82)。发现了 7 例 EB 病例,其中中性粒细胞减少症(p= 0.2)、插入前 48 小时内有 CVC 病史(p= 0.08)和术中 CVC(p= 0.04)的发生率较高。术中使用 CVC 会使 EB 风险增加 9 倍[OR:9.4(95%CI:1.288-69.712)(p= 0.027)]。缺乏术前预防并不会增加 EB 风险[OR:2.2 (CI:0.383-12.669) (p=0.3)]。与其他变量的相关性不显著:结论:在我们的患者中,术中存在CVC是EB的一个风险因素。术前预防对 EB 风险没有影响,因此我们认为不支持使用术前预防。不过,还需要进行样本量更大的进一步研究。确诊时白细胞减少或中性粒细胞减少与感染发生率增高无关。
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