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

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 [greater than or equal to] 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. Key Words osteomyelitis, central venous catheters, treatment, antibiotic use, pediatric Abbreviations AHO--acute hematogenous osteomyelitis IV--intravenous CVC--central venous catheter IQR--interquartile range CHOP--Children's Hospital of Philadelphia ED--emergency department PICC--peripherally inserted central catheter OPAT--outpatient parenteral antibiotic Therapy
EACH YEAR IN the United States, 1 of 5000 children A common approach to the treatment of AHO has consisted of several days of antibiotic administration through peripheral intravenous (IV) […]