부산대학교 도서관

Introduction Central venous access devices ( CVADs) are frequently required as stable long-lasting venous access in children with haemophilia, especially those requiring immune tolerance induction ( ITI) for inhibitors. CVAD infection is one of the most frequently reported catheter-related complications in this patient population. Aim Detailed review of CVAD complications from the International ITI (I- ITI) study and analysis of potential risk factors for such complications. Methods Retrospective analysis of prospectively obtained data from the I- ITI study primarily focused on CVAD-related complications. Results A total of 115 children were recruited and 183 CVADs were placed in 99 subjects resulting in 121,206 CVAD-days observed on-study. A total of 124 CVAD infections were reported in 41 of 99 (41%) subjects with an overall infection rate of 0.94 per 1000 CVAD-days (interquartile ranges 0-1.7). A similar number of infections were observed in the two treatment arms (median: 2 and 3 in high dose and low dose respectively). Infections occurred more frequently in the presence of external catheters than with fully implanted catheters ( P = 0.026). Infected patients were significantly younger at the time of CVAD insertion (median age: 22 vs. 25 months, P = 0.020). Patients with Gram-positive infections were also significantly younger than those with Gram-negative infections (median age: 17 vs. 25 months, P < 0.0001). Conclusion CVAD infection was the most common complication observed in children with severe haemophilia and inhibitors in the frame of the I- ITI study. Younger age at CVAD insertion and external CVAD were associated with higher risk for infection. ITI outcome was unaffected by CVAD infections. [ABSTRACT FROM AUTHOR]