Patient selection: acute leukemia with central venous catheter, neutropenia, and bloodstream infection
Criteria for central venous catheter related bloodstream infection:
(1) culture isolation of organism from at least one peripheral blood collection
(2) same organism isolated from at least one sample collected from the catheter
(3) no other identifiable source of infection
Septic thrombophlebitis was defined clinically as:
(1) presence of pain, induration, erythema, exudates and/or asymmetric venous distension
(2) at the catheter insertion site and/or ipsilateral arm and/or chest
Ultrasonography was performed on jugular, axillary and subclavian veins using a standard protocol. Septic thrombophlebitis was indicated by a clear intraluminal thrombus (as an >= 0.5 cm echogenic intravascular mass) at the CVC site. This can detect septic thrombophlebitis that was clinically silent.
Protocol:
(1) Confirm the presence of a bloodstream infection.
(2) Start appropriate antimicrobial therapy.
(3) Monitor the catheter site with ultrasonography.
(4) The catheter is removed if septic thrombophlebitis is identified.
(5) Conduct appropriate studies (repeat blood cultures, etc) as needed until infection has resolved.
