Hickman catheter-related infections in neutropenic patients: Insertion in the operating theater versus insertion in the radiology suite

Purpose: To determine the influence of microbial air quality during Hickman catheter insertion in the operating theater versus insertion in the radiology suite on the incidence of catheter-related infections (CRIs). Patients and Methods: Hemato-oncologic patients with prolonged neutropenia on antimicrobial prophylaxis were entered onto the study. Catheters were inserted experienced radiologists under sonographic and fluoroscopic guidance. Results: Forty-eight Hickman catheters in 39 patients were inserted (23 in the operating theater, 25 in the radiology suite). CRIs were seen in 16 catheters (33%; six per 1,000 catheter days; eight in each group). Local infections were found in nine catheters (22%; six in the operating theater v three in the radiology suite; not significant [NS]), catheter-related bacteremia was found in 10 (29%; three in the operating theater v seven in the radiology suite; NS). Coagulase-negative staphylococci (CONS) caused all CRIs. Despite early vancomycin therapy, 11 (69%; four in the operating room group v seven in the radiology suite group; NS) of the catheters with CRIs had to be removed prematurely. At 90 days after insertion, catheter survival was 78% and 60% (NS) for the operating room and radiology suite, respectively. Multivariate analysis showed that neutropenia increased the CRI risk 20-fold (P = .004) and was strongly related to premature catheter removal owing to infection (relative risk = 11.9; P = .009). Neutropenia on the day of insertion was also significantly correlated with CRI (P = .04) and premature catheter removal owing to infection (P = .03). Serial cultures of blood, exit site, and catheter hub did not predict the development of CRI. Conclusion: The high incidence of Hickman CRI caused CoNS was not associated with insertion location (operating theater v radiology suite). Neutropenia, including neutropenia on the day of insertion, was a significant risk factor for CRI and infection-related catheter removal.