Complicações infecciosas associadas ao uso de cateteres venosos centrais em pacientes submetidos a transplante de células-tronco hematopoéticas: incidência, fatores de risco e impacto em desfechos clínicos

Abstract

In the last decades, the use of central venous catheters (CVC) have become essential for health care, enabling the administration of fluids and electrolytes, antimicrobials, blood products, among others. The insertion of a CVC is routinely required in patients undergoinghematopoietic stem cell transplantation (HSCT), even though these devices may be associated with several complications, especially infectious ones. This study aimed to investigate the incidence, risk factors, and consequences of the infectious complications associated with CVC in a group of patients undergoing HSCT, at the Hospital das Clínicas, Universidade Federal de Minas Gerais (HC / UFMG). Patients admitted to undergo HSCT between May 2010 and June 2011 were prospectively included if they were 14 years of age, had received a CVCduring hospitalization, underwent HSCT within 28 days after the implantation of CVC, and signed a consent form. Patients were followed for 28 days for most outcomes, but "death" and "readmission" were also evaluated at 100 days after inclusion. Overall, 56 patients wereincluded in the study, 57% were men and the mean age was 39.4 years (SD: 15.8). Fifty-two percent of HSCT were autologous (AUT), and the remaining cases were allogeneic (ALO). Ninety-three percent of HSCT AUT had temporary CVC, and the most common anatomical site of insertion in these cases was the internal jugular vein (59%). In patients undergoing HSCT ALO, all CVC were semi-implanted (SI), and the main site of insertion was the subclavian vein (96%). Eleven episodes of laboratory-confirmed sepsis associated with CVC (SLCAC) and five episodes of infection in the exit site of the CVC were reported. The general incidence density (ID) of SLCAC was 9.5 per 1,000 CVC-days; 18.9 per 1,000 CVC-days for temporary catheter, and 5.0 per 1,000 CVC-days for SI catheter (p=0.579). Coagulasenegative Staphylococci was the main etiologic agent in SLCAC. When compared to thesubclavian vein, the insertion of CVC in the internal jugular vein (IJV) was independently associated with a seven-fold higher incidence of SLCAC (p = 0.038). Among the investigated endpoints, renal failure (RF) was the only event associated with the occurrence of catheter-associated infection during the follow-up of 28 days. We conclude that the DI of SLCAC found in this study was higher than those stated as acceptable by the maininternational recommendations. Among the risk factors evaluated, only CVC insertion in the IJV was associated with increased risk of infectious complications, and this anatomical site should be avoided in the future. The diagnosis of IAC was associated with the occurrence of RF during the follow-up. Therefore, closer observation to the renal function should be considered in these cases.