Prevention and management of long-term catheter related infections in cancer patients

Long-term central venous catheters (CVC) are necessary in the care of cancer patients. However, catheter-related bloodstream infection (CRBSI) is commonly associated with serious complications resulting in considerable morbidity and mortality. The diagnosis of CRBSI frequently requires catheter removal to confirm the diagnosis by either quantitative or semiquantitative catheter culture method. Differential time to positivity, whereby a nonquantitative blood culture drawn from the CVC that becomes positive at least 2 hr earlier than the peripheral blood culture, is a new method for the diagnosis of CRBSI without removing the catheter. Prevention of CRBSI may be accomplished with the use of strict infection control measures, antimicrobial-impregnated catheters, and antibiotic-lock technique, as well as other methods. Once infection develops, management of long-term CRBSI is dictated by the type of organism, the severity of the infection, and availability of other venous access sites. If the infection is caused by Staphylococcus aureus, gram-negative bacilli, or Candida, the catheter should be removed and systemic antimicrobial therapy given for 10-14 days or longer in cases of complicated or deep-seated infection. In some cases, where there is no other venous access site, the catheter can remain in place, but a combination of systemic antimicrobials and antibiotic-lock therapy should be used.