Generalisability and Cost-Impact of Antibiotic-Impregnated Central Venous Catheters for Reducing Risk of Bloodstream Infection in Paediatric Intensive Care Units in England

Background: We determined the generalisability and cost-impact of adopting antibiotic-impregnated CVCs in all paediatric intensive care units (PICUs) in England, based on results from a large randomised controlled trial (the CATCH trial; ISRCTN34884569). Methods: BSI rates using standard CVCs were estimated through linkage of national PICU audit data (PICANet) with laboratory surveillance data. We estimated the number of BSI averted if PICUs switched from standard to antibiotic-impregnated CVCs by applying the CATCH trial rate-ratio (0.40; 95% CI 0.17,0.97) to the BSI rate using standard CVCs. The value of healthcare resources made available by averting one BSI as estimated from the trial economic analysis was £10,975; 95% CI -£2,801,£24,751. Results: The BSI rate using standard CVCs was 4.58 (95% CI 4.42,4.74) per 1000 CVC-days in 2012. Applying the rate-ratio gave 232 BSI averted using antibiotic CVCs. The additional cost of purchasing antibiotic-impregnated compared with standard CVCs was £36 for each child, corresponding to additional costs of £317,916 for an estimated 8831 CVCs required in PICUs in 2012. Based on 2012 BSI rates, management of BSI in PICUs cost £2.5 million annually (95% uncertainty interval: -£160,986, £5,603,005). The additional cost of antibiotic CVCs would be less than the value of resources associated with managing BSI in PICUs with standard BSI rates >1.2 per 1000 CVC-days. Conclusions: The cost of introducing antibiotic-impregnated CVCs is less than the cost associated with managing BSIs occurring with standard CVCs. The long-term benefits of preventing BSI could mean that antibiotic CVCs are cost-effective even in PICUs with extremely low BSI rates

Primary Mediastinal Large B-Cell Lymphoma

Primary mediastinal large B-cell lymphoma (PMBCL) is a unique type of B-cell lymphoma probably arising from a putative thymic medullary B cell. It constitutes 6-10 % of all diffuse large B-cell lymphomas (DLBCL), occurring more often in young females. It is characterised by a diffuse proliferation of medium to large B cells associated with sclerosis and a degree of compartmentalisation. CD30 staining is observed in the vast majority of cases (~80 %), although it is weaker and less homogeneous than in cHL and anaplastic large-cell lymphoma. Molecular analysis shows it to be distinct from other types of DLBCL. PMBCL is characterised by an invasive anterior mediastinal mass, often producing local compressive symptoms. Some retrospective analyses suggested that it might respond better to third-generation chemotherapy regimens than to the more commonly used CHOP. However, the addition of rituximab reduced these differences and R-CHOP is now the most widely used treatment, as it is for other types of DLBCL. The role of consolidation with local radiotherapy, which is often used to treat residual mediastinal masses, still remains unclear. Treatment with R-CHOP followed by radiation therapy has excellent results, with a 5-year survival of 70-85 %. The role of FDG-PET scanning is the subject of prospective studies, and it is hoped that in the future, this will allow the de-escalation of radiation therapy based upon more accurate prognostic information as treatment proceeds. © Springer-Verlag Berlin Heidelberg 2014