Outcomes of Hickman Catheter Salvage in Febrile Neutropenic Cancer Patients WithStaphylococcus aureusBacteremia

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Abstract
Objective: To evaluate the outcome of attempted Hickman catheter salvage in neutropenic cancer patients withStaphylococcus aureusbacteremia who were not using antibiotic lock therapy.Design: Retrospective cohort study.Setting: A university-affiliated, tertiary-care hospital with 1,500 beds for adult patients.Patients: All neutropenic cancer patients who had a Hickman catheter andS. aureusbacteremia (32 episodes in 29 patients) between January 1998 and March 2002.Methods: Salvage attempts were defined as cases where the Hickman catheter was not removed until we obtained the results of follow-up blood cultures performed 48 to 72 hours after starting treatment with antistaphylococcal antibiotics. Salvage was considered to be successful if the Hickman catheter was still in place 3 months later without recurrent bacteremia or death.Results: Catheter salvage was attempted in 24 (75%) of the 32 episodes. Of the salvage attempts, the success rate was 50% (12 of 24). Salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures, and in 65% (11 of 17) of those with negative follow-up blood cultures (P= .07). If the analysis is confined to cases with no external signs of catheter infection, salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures and in 80% (8 of 10) of those with negative follow-up blood cultures (P= .02).Conclusion: In neutropenic cancer patients withS. aureusbacteremia, attempted catheter salvage without antibiotic lock therapy was successful in 50% of the cases.