888 infection control & hospital epidemiology july 2017, vol. 38, no. 7
Affiliation: 1. Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medi- cine, Ulsan, Republic of Korea; 2. Division of pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 3. Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 4. Division of High-Risk Pathogen Research, Center for Infectious Diseases, Centers for Disease Control & Prevention, Osong, Cheongju, Republic of Korea. Address correspondence to Jiwon Jung, MD, Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunwhando-ro, Dong-gu, Ulsan 44033, South Korea (
trueblue27@naver.com).
Yong-Woo Shin, MS;4 Jiwon Jung, MD1
Infect Control Hosp Epidemiol 2017;38:886–888 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0025. DOI: 10.1017/ice.2017.65
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1. Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med 2012;367:1035–1044.
2. Kim SW, Kwon GY, Kim B, Kwon D, Shin J, Bae GR. Imported melioidosis in South Korea: A case series with a literature review. Osong Public Health Res Perspect 2015;6:363–368.
3. Peacock SJ, Schweizer HP, Dance DA, et al. Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei. Emerg Infec Dis 2008;14:e2.
4. Gee JE, Sacchi CT, Glass MB, et al. Use of 16S rRNA gene sequencing for rapid identification and differentiation of Burkholderia pseudomallei and B. mallei. J Clin Microbiol 2003; 41:4647–4654.
5. Melioidosis (Burkholderia pseudomallei) 2012 case definition. Centers for Disease Control and Prevention website. https://
wwwn.cdc.gov/nndss/conditions/melioidosis/case-definition/2012/. Published 2012. Accessed March 22, 2017.
6. Benoit TJ, Blaney DD, Gee JE, et al. Melioidosis cases and selected reports of occupational exposures to Burkholderia pseu- domallei—United States, 2008–2013. MMWR Surveill Summ 2015;64:1–9.
7. Ashdown LR. Melioidosis and safety in the clinical laboratory. J Hosp Infec 1992;21:301–306.
recommended.1,2 The related studies were conducted in relatively small populations in general and especially in small populations of cancer patients; in addition, thrombocytopenia, which often occurs in cancer patients, was an exclusion criterion in these trials.3,4 However, prophylactic CVC exchange is sometimes still clinical practice in hematology, even though the optimal time point is unclear. Therefore, we aimed to investigate this question in a larger cohort of patients with hematological malignancies. For this purpose, pooled data from the prospective Study to Evaluate Central venous Catheter-related Infections in Hematology and Oncology (SECRECY) registry (German Clinical Trial Register No. DRKS00006551)5 and the pro- spective Antimicrobial Catheter Securement Dressings for the Prevention of CVC-related Bloodstream Infections in Cancer Patients (COAT) study (
ClinicalTrials.gov No. NCT01544686)6 from 11 centers in Germany were analyzed. SECRECY is an ongoing real-life registry of CRBSI in patients with hematological and oncological
malignancies.COAT was a randomized multicenter trial comparing different CVC dres- sings in terms of CRBSI incidence in neutropenic patients. In this study, we analyzed CRBSI due to short-term CVC
(≥1 day in situ) inserted in the jugular or subclavian vein in patients with hematological malignancies. Only definitive CRBSI (dCRBSI) and the combination of definitive and probable CRBSI (dpCRBSI) according to the 2012 Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology (AGIHO/DGHO) criteria2 were con- sidered from both data subsets. Using a receiver operating characteristic, CVC duration was used to determine a cutoff time point for CRBSI risk. An area under the curve (AUC) of <0.500 and 0.500–0.700 were considered of no and low pre- dictive significance, respectively.7 Altogether, 1,194 CVC patients (median age, 59 years;
Determination of a Cutoff Time Point for Prophylactic Exchange of Central Venous Catheters for Prevention of Central Venous Catheter–Related Bloodstream Infections in Patients with Hematological Malignancies
To the Editor—Prophylactic exchange of central venous catheters (CVC) for prevention of CVC-related bloodstream infections (CRBSI) in cancer patients is not generally
range, 18–86; 59.2% men) with 20,330 CVC days (median CVC duration, 17 days; range, 1–60) were analyzed. In total, 610 CVC patients (51.1%) were from the COAT study and 584 (48.9%) were from the SECRECY registry. Underlying diseases were acute leukemia in 568 of these patients (47.6%), multiple myeloma in 316 patients (26.5%), and lymphoma in 226 patients (18.9%). The insertion site was the jugular vein in 819 of these patients (68.6%) and the subclavian vein in 375 patients (31.4%). In 890 of these patients (74.5%), chlorhexidine-containing CVC dressings were used from the beginning of the CVC insertion. In total, 55 dCRBSIs and 137 dpCRBSIs occurred. Definitive
CRBSI originated in the jugular vein CVC in 26 of these 55 patients (47.3%); dpCRBSI originated in the jugular vein CVC in 87 of 137 dp CRBSI patients (63.5%). The epidemiological data are summarized in Table 1. The CVC duration was the same for CVC with dCRBSI and dpCRBSI (median, 16 vs 16 days; P=.62). No significant difference was detected between dCRBSI onset and dpCRBSI onset (median, 14 vs 13 days; P=.24). Comparing dCRBSI onset with dpCRBSI onset in jugular vein CVC, we also found no significant
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