1023.  Blood Culture Collection and Interpretation Practice Patterns in Oncology Patients with Indwelling Central Lines
Session: Poster Abstract Session: Diagnosis of Bloodstream / Cardiovascular Infections
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Because of immunosuppression and need for long-term indwelling catheters, oncology patients are particularly prone to central line infections.  However, variability in blood culture (BC) practices may impact central line-associated bloodstream infection (CLABSI) diagnosis and decisions regarding catheter removal.

Methods: We identified all patients with an initial positive BC at oncology units in our center between 1/1/2010 and 3/31/2010.  We retrospectively collected clinical data including cancer diagnosis, central line information, neutropenic status, DNR status, and if the central line was removed.  We also collected data on BC source labeling and analyzed its impact on probability of defining positive BC as CLABSI and on probability of line removal. Only one event per patient was analyzed.

Results: 106 oncology patients with ≥1 positive BC were identified. Median age was 56 years (range, 19-83), 48% male, and 51% were neutropenic. The median LOS was 19 days (range, 2-120). 77 (73%) subjects had a hematologic malignancy and 87 (83%) had ≥1 central line in place at the time of BC (Hickman, Port-a-Cath, and/or PICC).  Among patients with central lines, 214 BC sets (median 2 per patient, range 1-5) were obtained at time of BC positivity. In 72 patients, at least 1 BC set was labeled; all BC draws were labeled in 52 (49.1%). Peripheral BC were not obtained or not documented in 39 (45%) patients. Coagulase-negative Staphylococcus was the most commonly isolated organism (40%) followed by Gram-negative rods (24%). BC were classified as CLABSI in 19 (17.9%) patients and central access was removed in 39 (44%) patients. BC source labeling was associated with higher odds of line removal (OR 2.28, 95% CI, 0.81-6.30)

Conclusion: We found that oncology patients, most of whom had indwelling central lines, had high rates of undocumented BC sources; source labeling was associated with higher rates of catheter removals, even in patients not meeting CLABSI criteria. This suggests that interventions to obtain at least one BC set from a peripheral vein and consistent source labeling may reduce the risk of positive BC resulting from contaminants, leading to potentially unnecessary catheter removal and exposure to antimicrobial therapy.




Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Fatima Rodriguez, MD, MPH1, Humberto Licona, MD2, Candance Hsieh, RN, CIC3, Deborah Yokoe, MD, MPH4 and Francisco Marty, MD1,5,6, (1)Harvard Medical School, Boston, MA, (2)Infectious Disease, Brigham and Women's Hospital, Boston, MA, (3)Infection Control, Brigham and Women's Hospital, Boston, MA, (4)Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA, Boston, MA, (5)Brigham and Women's Hospital, Boston, MA, (6)Dana-Farber Cancer Institute, Boston, MA

Disclosures:

F. Rodriguez, None

H. Licona, None

C. Hsieh, None

D. Yokoe, None

F. Marty, None

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