Management of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBIs) in Stem Cell Transplant Recipients: A National Survey of Cancer Centers Practices
Year: 2019
Type: article
Study design: Observational Study
Abstract: Background Patients with hematologic malignancies receiving chemotherapy and those undergoing stem cell transplantation (SCT) are at risk for mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs). Our comprehensive cancer center, which performs over 300 SCTs per year, has historically removed central venous catheters (CVCs) for the majority of transient MBI- LCBI cases in SCT recipients. However, given the lack of evidence-based guidelines for removal or salvage, we created a national survey to gauge current clinical practice of MBI-LCBI and CVC management among U.S. cancer centers. Methods We created a 22-item online anonymous survey via Qualtrics software. The survey was performed in August and September of 2018 and open for a total of 30 days. The questionnaire consisted of three parts: respondents' characteristics, MBI-LCBI and CVC clinical practice questions, and two clinical vignettes. In parallel, a quality improvement project is ongoing to evaluate outcomes following catheter salvage versus removal in MBI-LCBI cases of SCT recipients. Results The survey was distributed to seventy Infectious Diseases consultants at cancer centers in the United States. The response rate was 44%. 70% of respondents had > 5 years of clinical experience. The majority (75%) responded that MBI-LCBI does not implicate the CVC as the source of bacteremia. 61% of respondents salvage CVCs in SCT patients unless contraindicated. In patients with salvaged CVCs, 37.5% of responders do not use adjunct lock therapy and 46% deem repeat end of therapy surveillance blood culture as unnecessary. 62.5% of responders do not routinely recommend other procedures such as venous duplex ultrasound and transthoracic echocardiogram for MBI-LCBI cases unless clinically indicated. Among 90% of respondents deemed fluoroquinolone step down oral therapy for susceptible Enterobacteriaceae MBI-LCBI as acceptable. Conclusion Management of MBI-LCBIs in hematologic malignancies and SCT patients is variable but CVC salvage is considered by a majority of survey respondents as a safe approach. Data comparing outcomes of catheter salvage strategies are lacking. Results of our ongoing quality improvement project will provide further guidance.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2911807518