Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis

Rebecca Ruebner, Ron Keren, Susan Coffin, Jaclyn Chu, David Horn, Theoklis E. Zaoutis

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. To determine the complications and risk factors for complications associated with using central venous catheters (CVCs) for the treatment of acute hematogenous osteomyelitis (AHO). METHODS. We conducted a retrospective cohort study of all patients admitted to the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2003, with a diagnosis of AHO. RESULTS. Eighty patients with AHO met inclusion criteria. The median age was 5 years, and 66% of the patients were male. The most commonly affected bones were the femur (25%), tibia (20%), and pelvis (16%). Staphylococcus aureus was the most common organism identified from cultures of bone (67%) and blood (30%). Seventy-five patients (94%) received >2 weeks of intravenous (IV) antibiotic therapy via a CVC and 5 (6%) received <2 weeks of IV antibiotic therapy before conversion to oral therapy for a median of 25 days. None of the patients who switched to oral therapy within 2 weeks was rehospitalized or returned to the emergency department. Of the 75 patients who received >2 weeks of IV therapy, 41% had ≥1 CVC-associated complication. Seventeen patients (23%) had a CVC malfunction or displacement, 8 (11%) had a catheter-associated bloodstream infection, 8 (11%) had fever with negative blood culture results, and 4 (5%) had a local skin infection at the site of catheter insertion. Older age was protective against the development of a CVC-associated complication, whereas the lowest median household income was associated with development of a CVC-associated complication. CONCLUSIONS. Interventions to reduce CVC-associated complications should be developed and evaluated, particularly for young children and those from families with low household incomes. Clinical trials are needed to evaluate the safety and efficacy of oral antibiotic therapy after a short course of IV therapy as an alternative to prolonged IV therapy.

Original languageEnglish (US)
Pages (from-to)1210-1215
Number of pages6
JournalPediatrics
Volume117
Issue number4
DOIs
StatePublished - 2006
Externally publishedYes

Fingerprint

Central Venous Catheters
Osteomyelitis
Therapeutics
Anti-Bacterial Agents
Bone and Bones
Catheter-Related Infections
Complementary Therapies
Pelvis
Tibia
Femur
Staphylococcus aureus
Cohort Studies
Fever
Catheters
Retrospective Studies
Clinical Trials
Safety
Skin
Infection

Keywords

  • Antibiotic use
  • Central venous catheters
  • Osteomyelitis
  • Pediatric
  • Treatment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis. / Ruebner, Rebecca; Keren, Ron; Coffin, Susan; Chu, Jaclyn; Horn, David; Zaoutis, Theoklis E.

In: Pediatrics, Vol. 117, No. 4, 2006, p. 1210-1215.

Research output: Contribution to journalArticle

Ruebner, Rebecca ; Keren, Ron ; Coffin, Susan ; Chu, Jaclyn ; Horn, David ; Zaoutis, Theoklis E. / Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis. In: Pediatrics. 2006 ; Vol. 117, No. 4. pp. 1210-1215.
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T1 - Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis

AU - Ruebner, Rebecca

AU - Keren, Ron

AU - Coffin, Susan

AU - Chu, Jaclyn

AU - Horn, David

AU - Zaoutis, Theoklis E.

PY - 2006

Y1 - 2006

N2 - OBJECTIVE. To determine the complications and risk factors for complications associated with using central venous catheters (CVCs) for the treatment of acute hematogenous osteomyelitis (AHO). METHODS. We conducted a retrospective cohort study of all patients admitted to the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2003, with a diagnosis of AHO. RESULTS. Eighty patients with AHO met inclusion criteria. The median age was 5 years, and 66% of the patients were male. The most commonly affected bones were the femur (25%), tibia (20%), and pelvis (16%). Staphylococcus aureus was the most common organism identified from cultures of bone (67%) and blood (30%). Seventy-five patients (94%) received >2 weeks of intravenous (IV) antibiotic therapy via a CVC and 5 (6%) received <2 weeks of IV antibiotic therapy before conversion to oral therapy for a median of 25 days. None of the patients who switched to oral therapy within 2 weeks was rehospitalized or returned to the emergency department. Of the 75 patients who received >2 weeks of IV therapy, 41% had ≥1 CVC-associated complication. Seventeen patients (23%) had a CVC malfunction or displacement, 8 (11%) had a catheter-associated bloodstream infection, 8 (11%) had fever with negative blood culture results, and 4 (5%) had a local skin infection at the site of catheter insertion. Older age was protective against the development of a CVC-associated complication, whereas the lowest median household income was associated with development of a CVC-associated complication. CONCLUSIONS. Interventions to reduce CVC-associated complications should be developed and evaluated, particularly for young children and those from families with low household incomes. Clinical trials are needed to evaluate the safety and efficacy of oral antibiotic therapy after a short course of IV therapy as an alternative to prolonged IV therapy.

AB - OBJECTIVE. To determine the complications and risk factors for complications associated with using central venous catheters (CVCs) for the treatment of acute hematogenous osteomyelitis (AHO). METHODS. We conducted a retrospective cohort study of all patients admitted to the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2003, with a diagnosis of AHO. RESULTS. Eighty patients with AHO met inclusion criteria. The median age was 5 years, and 66% of the patients were male. The most commonly affected bones were the femur (25%), tibia (20%), and pelvis (16%). Staphylococcus aureus was the most common organism identified from cultures of bone (67%) and blood (30%). Seventy-five patients (94%) received >2 weeks of intravenous (IV) antibiotic therapy via a CVC and 5 (6%) received <2 weeks of IV antibiotic therapy before conversion to oral therapy for a median of 25 days. None of the patients who switched to oral therapy within 2 weeks was rehospitalized or returned to the emergency department. Of the 75 patients who received >2 weeks of IV therapy, 41% had ≥1 CVC-associated complication. Seventeen patients (23%) had a CVC malfunction or displacement, 8 (11%) had a catheter-associated bloodstream infection, 8 (11%) had fever with negative blood culture results, and 4 (5%) had a local skin infection at the site of catheter insertion. Older age was protective against the development of a CVC-associated complication, whereas the lowest median household income was associated with development of a CVC-associated complication. CONCLUSIONS. Interventions to reduce CVC-associated complications should be developed and evaluated, particularly for young children and those from families with low household incomes. Clinical trials are needed to evaluate the safety and efficacy of oral antibiotic therapy after a short course of IV therapy as an alternative to prolonged IV therapy.

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KW - Central venous catheters

KW - Osteomyelitis

KW - Pediatric

KW - Treatment

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