Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

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Abstract

Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter–related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.

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Most cited references 186

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Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.

Leonard A. Mermel, Michael Allon, Emilio Bouza … (2009)

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Nurse-staffing levels and the quality of care in hospitals.

Jack Needleman, Peter Buerhaus, Soeren Mattke … (2002)

It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. We used administrative data from 1997 for 799 hospitals in 11 states (covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients' outcomes. We conducted regression analyses in which we controlled for patients' risk of adverse outcomes, differences in the nursing care needed for each hospital's patients, and other variables. The mean number of hours of nursing care per patient-day was 11.4, of which 7.8 hours were provided by registered nurses, 1.2 hours by licensed practical nurses, and 2.4 hours by nurses' aides. Among medical patients, a higher proportion of hours of care per day provided by registered nurses and a greater absolute number of hours of care per day provided by registered nurses were associated with a shorter length of stay (P=0.01 and P<0.001, respectively) and lower rates of both urinary tract infections (P<0.001 and P=0.003, respectively) and upper gastrointestinal bleeding (P=0.03 and P=0.007, respectively). A higher proportion of hours of care provided by registered nurses was also associated with lower rates of pneumonia (P=0.001), shock or cardiac arrest (P=0.007), and "failure to rescue," which was defined as death from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis (P=0.05). Among surgical patients, a higher proportion of care provided by registered nurses was associated with lower rates of urinary tract infections (P=0.04), and a greater number of hours of care per day provided by registered nurses was associated with lower rates of "failure to rescue" (P=0.008). We found no associations between increased levels of staffing by registered nurses and the rate of in-hospital death or between increased staffing by licensed practical nurses or nurses' aides and the rate of adverse outcomes. A higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients.

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Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs.

Craig A Umscheid, Matthew D. Mitchell, Jalpa Doshi … (2011)

To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are "reasonably preventable," along with their related mortality and costs. To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of "moderate" to "good" quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI. As many as 65%-70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less. Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars.

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Author and article information

Contributors

Boris Böll:

ORCID: https://orcid.org/0000-0002-6432-0981

boris.boell@uk-koeln.de

Journal

Journal ID (nlm-ta): Ann Hematol

Journal ID (iso-abbrev): Ann Hematol

Title: Annals of Hematology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0939-5555

ISSN (Electronic): 1432-0584

Publication date (Electronic): 30 September 2020

Publication date PMC-release: 30 September 2020

Publication date (Print): 2021

Volume: 100

Issue: 1

Pages: 239-259

Affiliations

[1 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, , University of Cologne, ; Kerpener Strasse 62, 50937 Cologne, Germany

[2 ]GRID grid.5807.a, ISNI 0000 0001 1018 4307, Department of Hematology and Oncology, , Otto-von-Guericke University Magdeburg, Medical Center, ; Magdeburg, Germany

[3 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Department of Hematology and Oncology, Mannheim University Hospital, , Heidelberg University, ; Mannheim, Germany

[4 ]Clinic for Hematology and Oncology, University Medicine Göttingen, Georg-August-University, Göttingen, Germany

[5 ]Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany

[6 ]Department of Hematology, Oncology and Palliative Care, Vivantes Clinic Neukoelln, Berlin, Germany

[7 ]GRID grid.5718.b, ISNI 0000 0001 2187 5445, Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, , University of Duisburg-Essen, ; Essen, Germany

[8 ]GRID grid.10253.35, ISNI 0000 0004 1936 9756, Department of Hematology and Oncology, Campus Fulda, , Philipps-University Marburg, ; Fulda, Germany

[9 ]GRID grid.412468.d, ISNI 0000 0004 0646 2097, Department of Hematology and Oncology, , University Hospital Oldenburg, ; Oldenburg, Germany

[10 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Hematology, Oncology, and Tumor Immunology, , Charité - Universitätsmedizin Berlin, ; Berlin, Germany

[11 ]Department of Hematology and Oncology, Helios Klinikum Aue, Aue, Germany

[12 ]GRID grid.7839.5, ISNI 0000 0004 1936 9721, Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, , Goethe University Frankfurt, ; Frankfurt am Main, Germany

[13 ]Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany

[14 ]Department III of Internal Medicine, Hematology, Oncology and Hemostaseology, Südharzklinikum, Nordhausen, Germany

[15 ]GRID grid.507575.5, Department of Hematology, Oncology & Palliative Care, , Klinikum Neuperlach, ; Munich, Germany

[16 ]Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany

Author information

Boris Böll https://orcid.org/0000-0002-6432-0981

Article

Publisher ID: 4286

DOI: 10.1007/s00277-020-04286-x

PMC ID: 7782365

PubMed ID: 32997191

SO-VID: 90426f42-d830-4124-bd40-d4187d8ae194

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 11 August 2020

Date accepted : 23 September 2020

Funding

Funded by: Universitätsklinikum Köln (8977)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Hematology

Keywords: central venous catheter,catheter infection,crbsi,clabsi,neutropenia,cancer

Data availability:

ScienceOpen disciplines: Hematology

Keywords: central venous catheter, catheter infection, crbsi, clabsi, neutropenia, cancer

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

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Hematology and Oncology Discovery

Most cited references 186

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.

Nurse-staffing levels and the quality of care in hospitals.

Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs.

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Article

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