1. Title of the Poster Presentation Placed Here
Epidemiology of Catheter-Associated Bloodstream Infections in outpatients undergoing chemotherapy at AC Camargo Cancer Center
Joseanne Lima, Adriana Costa e Silva, Paula Regolin, Adenilde Andrade, Beatriz Quental, Juliana Monteiro Virolli, Maysa Bonfleur Alves, Ivan, França
A C Camargo Cancer Center
Title of the Poster Presentation Placed Here
Authors of the Poster Presentation Placed Here Institutional and/or Graduate School of Biomedical Sciences Affiliation Placed Here
GAP 2015 Conference
Results
Objective
Describe the epidemiology of long-term CLABSI in patients who are undergoing outpatient chemotherapy in the years 2013 and
Introduction
Cancer patients undergoing chemotherapy use long-term intravascular catheters. The main infection risk factors related to this device are immunosuppression and the handling of catheters. Careful monitoring of Central line-associated bloodstream infection (CLABSI) is decisive when planning preventive measures for this specific group of patients. 1, 2
Central line-associated bloodstream infection is among the most common Health Associated Infection (HAIs) and results in significant morbidity , and in crude mortality. The CDC-NHSN defines CLABSI as bacteremia with a recognized pathogen when the organism isolated from blood culture is not related to infection skin contaminant from two or more blood cultures associated with signs and symptoms of infection that can’t be attributed to infection at another site. 1,2
Inappropriate practice insertion and maintenance of catheters in cancer patients rise the risk of infection, increasing mortality, morbidity and the cost of hospitalization. Plan and implement preventive measures are essential to reducing rates (CLABSI).
Moreover interventions based in evidence, epidemiology and pathogenesis of these infections can show us how to improve patients care. 1,2
In table 1 we observe the types of catheters used in outpatient chemotherapy in 2013 and 2014.
In 2013, 17 infections were reported, which represents a 1,21 density of infection incidence. 53% were females, the median age infection cases in 2013 was 56 years, 82% had solid tumors, 18% hematological and 71% port-a-cath related. (Figure 1,2) In 2014, there were 11 infections, which represents a 0,67 density of infection incidence, 36% were males, the median age infection cases in 2014 was 53 years, 55% had solid tumors, 45% hematological and 55% port-a-cath related. (Figure 4,5) Epidemiology, when considering those 2 years was 38% of Coccus Gram Positive (CGP) and 62% of Bacillus Gram-Negative (BGN) ( Figure 6). The most common infection agents were Staphylococcus aureus, Coagulase-negative Staphylococcus (CNS) and E. coli. (Figure 7) Among BGN agents, all those isolated were multi-sensitive except one Klebsiella pneumoniae ESBL, and 63,6% of CGP are Oxacillin-sensitive.
Figure 1. Distribution by gender, 2013
Figure 4. Distribution by gender, 2014
Methodology
AC Camargo Cancer Center has 3423 monthly outpatient visits, outpatient of chemotherapy with three units, located in São Paulo, Brazil. Those patients under chemotherapy are using long-term central venous catheter. The puncture these catheters was performed under asseptic conditions, by preparing patient's skin with degerming chlorhexidine solution 2% and alcoholic chlorhexidine 0.5%. The indicators are measure by a chemotherapy nurse, through froms, which are count daily patient, daily catheter, and also the type.
Figure 7. Distribution of ethiological agents,
Conclusion
The knowledge of local epidemiology is decisive to manage prevention strategies of CR-BSI in cancer patients. Dealing with this high infection-risk patient group, who is in regular contact with a number of different health professionals, from insertion of catheters to their removal, requires a health-care team updated in prevention of CLABSI
Figure 2. Distribution of solids and hematological tumors, 2013
Figure 5. Distribution of solids and hematological tumors, 2014
References
1) NHSN. National and State Healthcare-Associated Infections Standardized Infection Ratio Report. 29_2012.pdf. [Accessed on 15 March 2015]
2) Lipitz Snyderman A, Sepkowitz Ka et al. Long-term central venous catheter use and risk of infection in older adults with cancer, J Clin Oncol. 2014 Aug 1;32(22):
3) Steinberg JP, Robichaux C et al, Distribution of pathogens in central line-associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013 Feb;34(2):171-5.
Figure 3. Median age,
Figure 6. Distribution of isolated germs.
Table 1. Catheter used in,