CENTRAL VENOUS CATHETER INFECTION IN HEMOPHILIACS UNDERGOING PROPHYLAXIS OR IMMUNE TOLERANCE WITH CLOTTING FACTOR CONCENTRATE

The risk of infection in individuals with haemophilia using central va scular access devices for administration of clotting factor concentrat es for prophylaxis or immune tolerance is unknown. We conducted a surv ey of US haemophilia treatment centres to determine the incidence and clinical characteristics of infection associated with the use of centr al venous catheters. Seventy (38.3%) of 183 patients using central lin es developed device-associated infection, including 30 (28.0%) on prop hylaxis and 40 (52.6%) on immune tolerance, P < 0.005. Over half (54.8 %) the infections occurred in those less than or equal to 3 years of a ge. Implanted/tunnelled devices (port catheters) were more likely to b ecome infected in the first 30 days after insertion, 11 of 41 (26.8%), than external catheters (broviac/hickman), none of 29 (0%), P = 0.000 03. The median time to infection from initial device placement, 124 da ys, varied with age, 57 days in those less than or equal to 2 years of age vs. 161 days in those > 2 years of age, P = 0.0008, but not with type of device or treatment. Staphylococcal infections were more commo n with implanted devices (ports), 30 (73.2%), than external catheters, 12 (41.4%), P < 0.01, and Gram-negative infections were more common w ith external catheters, 17 (58.6%), than tunnelled devices, 7 (17.1%), P < 0.005. In summary, the rate of infection with central venous acce ss devices in haemophiliacs is high, and alternative approaches to ven ous access should be explored.