Session: 721. Clinical Allogeneic Transplantation: Conditioning Regimens, Engraftment, and Acute Transplant Toxicities: Poster II
Hematology Disease Topics & Pathways:
Adult, Adverse Events, Technology and Procedures, Study Population, Clinically relevant
- To determine the incidence and incidence rate per 1000 catheter-days within the autologous HSCT program at Eastern Health
- To identify protective and risk factors associated with CVCs in HSCT patients
- Describe the causative agents in CVC infectious complication identified by blood and catheter-tip culture results
Methods: Charts of all adult patients with hematologic malignancy who underwent HSCT with CVC placement at Eastern Health between January 1, 2014 and March 1, 2020 were examined to determine which patients experienced any of a catheter-related bloodstream, tunneled-line or exit site infectious complication as defined by the Public Health Agency of Canada’s surveillance definitions. Risk factors assessed included patient factors (age, malignancy, history of bacteremia, fungemia or radiation therapy), immunosuppressive factors (lines of chemotherapy, total 90 day corticosteroid burden, erythropoietin use, days to polymorphonuclear cells >500/µL), and CVC factors (line type, insertion site, antibiotic prophylaxis, heparin impregnation, training level of radiologist, days indwelling, thrombotic complication. Additional data captured included 90-day mortality, whether the CVC was terminated and the causative organism identified by blood or catheter-tip culture.
Preliminary Results: The incidence of total infectious complications was 56.2% with an incidence of catheter-related bloodstream infection (CR-BSI) of 22.9%. The incidence rate for total infectious complications was 6.51 per 1000-catheter days, with a CR-BSI infectious rate of 2.65. Both incidence and incidence rate were below results found in other centres. In univariate analysis found single-line of chemotherapy (HR 0.114, p=0.001), use of Permacath (HR 0.03, p=0.002), right internal jugular placement (HR 0.048, p=0.006) to be protective for infectious complication. Multivariate analysis identified a history of bacteremia (OR 763.1, p=0.039) and total days CVC indwelling (OR 0.94, p=0.011) to be associated with CVC infectious complication.
Conclusion: Modifiable risk factors associated with CVC infectious complication are choice of device and placement site. Risk factors such as multiple lines of previous chemotherapy or history of bloodstream infection signal need to increased observation for infection.
Disclosures: No relevant conflicts of interest to declare.
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