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Post-transplant Complications

Incidence of and risk factors for persistent gram-positive bacteraemia and catheter-related thrombosis in haematopoietic stem cell transplantation

Bone Marrow Transplantation volume 49, pages 264–269 (2014)Cite this article

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Abstract

A cohort of 439 haematopoietic SCT recipients was analysed to determine the incidence of Gram-positive coccal bacteraemia and thromboembolic events associated with the use of central venous catheters (CVCs) and to determine risk factors for these complications. The incidences of persistent coagulase-negative staphylococcal (CoNS) bacteraemia, symptomatic thrombosis and thrombophlebitis were 25%, 9.6% and 6.6%, respectively. Duration of neutropenia (in days, odds ratio (OR) 1.02; P=0.04) and left-sided placement of the CVCs (OR 1.73; P=0.03) were independent risk factors for the occurrence of persistent CoNS bacteraemia, whereas the use of less mucotoxic conditioning regimens was associated with a lower risk (high-dose melphalan (HDM)/BEAM vs other regimens, OR 0.24; P<0.001). Use of TBI, persistent CoNS bacteraemia and tip colonisation were all significantly associated with an increased risk of symptomatic thrombosis (OR 6.03, 3.36 and 2.80, respectively; P⩽0.02). The risk factors found in this cohort of SCT recipients differed from those found in the general cancer population, showing an important role for persisting bacteraemia in the pathogenesis of CVC-associated thrombosis. Therefore, we constructed a new algorithm in order to improve catheter management and prevent these CVC-related complications.

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Author notes

  1. A Richters and M van Vliet: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    A Richters, M van Vliet, B A P Laros-van Gorkom, N M A Blijlevens, J P Donnelly & W J F M van der Velden

  2. Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    P G M Peer

  3. Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    P E Verweij, N M A Blijlevens, J P Donnelly & W J F M van der Velden

  4. Department of Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    P E Verweij

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  1. A Richters
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Correspondence to W J F M van der Velden.

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AR, MvV, JPD and WvdV conceived and designed the study; AR, MvV and JPD acquired the data; AR and WvdV analysed the data; AR, MvV, JPD and WvdV interpreted the results; and AR, MvV, JPD and WvdV drafted the manuscript. All authors revised the manuscript and approved the final version.

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Richters, A., van Vliet, M., Peer, P. et al. Incidence of and risk factors for persistent gram-positive bacteraemia and catheter-related thrombosis in haematopoietic stem cell transplantation. Bone Marrow Transplant 49, 264–269 (2014). https://doi.org/10.1038/bmt.2013.172

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