Hostname: page-component-669899f699-chc8l Total loading time: 0 Render date: 2025-04-26T06:46:28.138Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia

Published online by Cambridge University Press:  25 April 2022

Caitlin W. Elgarten Open the ORCID record for Caitlin W. Elgarten [Opens in a new window] ,
William R. Otto Open the ORCID record for William R. Otto [Opens in a new window] ,
Luke Shenton Open the ORCID record for Luke Shenton [Opens in a new window] ,
Madison T. Stein ,
Joseph Horowitz ,
Catherine Aftandilian Open the ORCID record for Catherine Aftandilian [Opens in a new window] ,
Staci D. Arnold Open the ORCID record for Staci D. Arnold [Opens in a new window] ,
Kira O. Bona Open the ORCID record for Kira O. Bona [Opens in a new window] ,
Emi Caywood Open the ORCID record for Emi Caywood [Opens in a new window]  and
Anderson B. Collier Open the ORCID record for Anderson B. Collier [Opens in a new window]
...Show all authors
Caitlin W. Elgarten*
Affiliation:
Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
William R. Otto
Affiliation:
Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Luke Shenton
Affiliation:
Drexel University College of Medicine, Philadelphia, Pennsylvania
Madison T. Stein
Affiliation:
Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Joseph Horowitz
Affiliation:
College of Medicine, University of Illinois
Catherine Aftandilian
Affiliation:
Division of Pediatric Hematology-Oncology, Department of Pediatrics, Stanford University, Palo Alto, California
Staci D. Arnold
Affiliation:
Children’s Healthcare of Atlanta/Emory University, Atlanta, Georgia
Kira O. Bona
Affiliation:
Pediatric Hematology-Oncology, Children’s Hospital Boston, Boston, Massachusetts
Emi Caywood
Affiliation:
A.I. Dupont Hospital for Children–Nemours, Wilmington, Delaware
Anderson B. Collier
Affiliation:
University of Mississippi Medical Center, Jackson, Mississippi
M. Monica Gramatges
Affiliation:
Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
Meret Henry
Affiliation:
Children’s Hospital of Michigan, Detroit, Michigan
Craig Lotterman
Affiliation:
Ochsner Medical Center for Children, New Orleans, Lousisiana
Kelly Maloney
Affiliation:
Children’s Hospital Colorado and the Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
Arunkumar J. Modi
Affiliation:
Arkansas Children’s Hospital, Little Rock, Arkansas
Amir Mian
Affiliation:
Arkansas Children’s Hospital, Little Rock, Arkansas
Rajen Mody
Affiliation:
University of Michigan, Ann Arbor, Michigan
Elaine Morgan
Affiliation:
Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
Elizabeth A. Raetz
Affiliation:
Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders, New York, New York
Anupam Verma
Affiliation:
Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
Naomi Winick
Affiliation:
Department of Pediatric Hematology Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
Jennifer J. Wilkes
Affiliation:
Department of Pediatrics, University of Washington, Division of Hematology-Oncology, Seattle Children’s Hospital, Seattle, Washington
Jennifer C. Yu
Affiliation:
Division of Pediatric Hematology-Oncology, Rady Children’s Hospital San Diego, San Diego, California
Richard Aplenc
Affiliation:
Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Brian T. Fisher
Affiliation:
Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Kelly D. Getz
Affiliation:
Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Caitlin W. Elgarten, MD, MSCE, E-mail: elgarten@chop.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.

Objective:

To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.

Methods:

We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.

Results:

The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75–1.32) and TIC IRR = 0.83 (95% CI, 0.49–1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.

Conclusions:

In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 2 , February 2023 , pp. 222 - 229
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

PREVIOUS PRESENTATION. This study was in part at the American Society for Hematology Annual Meeting, December 11, 2017 in Atlanta, Georgia.

References

Lehrnbecher, T, Varwig, D, Kaiser, J, Reinhardt, D, Klingebiel, T, Creutzig, U. Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93. Leukemia 2004;18:72–77.CrossRefGoogle ScholarPubMed
Sung, L, Aplenc, R, Zaoutis, T, Groll, AH, Gibson, B, Lehrnbecher, T. Infections in pediatric acute myeloid leukemia: lessons learned and unresolved questions. Pediatr Blood Cancer 2008;51:458–460.CrossRefGoogle ScholarPubMed
Sung, L, Lange, BJ, Gerbing, RB, Alonzo, TA, Feusner, J. Microbiologically documented infections and infection-related mortality in children with acute myeloid leukemia. Blood 2007;110:3532–3539.CrossRefGoogle ScholarPubMed
Molgaard-Hansen, L, Mottonen, M, Glosli, H, et al. Early and treatment-related deaths in childhood acute myeloid leukaemia in the Nordic countries: 1984–2003. Br J Haematol 2010;151:447–459.CrossRefGoogle ScholarPubMed
Lech-Maranda, E, Seweryn, M, Giebel, S, et al. Infectious complications in patients with acute myeloid leukemia treated according to the protocol with daunorubicin and cytarabine with or without addition of cladribine. A multicenter study by the Polish Adult Leukemia Group (PALG). Int J Infect Dis 2010;14:e132–e140.CrossRefGoogle ScholarPubMed
Rogers, AE, Eisenman, KM, Dolan, SA, et al. Risk factors for bacteremia and central-line–associated bloodstream infections in children with acute myelogenous leukemia: a single-institution report. Pediatr Blood Cancer 2017;64. doi: 10.1002/pbc.26254.CrossRefGoogle ScholarPubMed
Sung, L, Gamis, A, Alonzo, TA, et al. Infections and association with different intensity of chemotherapy in children with acute myeloid leukemia. Cancer 2009;115:1100–1108.CrossRefGoogle ScholarPubMed
Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–1171.CrossRefGoogle ScholarPubMed
Rinke, ML, Bundy, DG, Chen, AR, et al. Central-line maintenance bundles and CLABSIs in ambulatory oncology patients. Pediatrics 2013;132:e1403–e1412.CrossRefGoogle ScholarPubMed
Hord, JD, Lawlor, J, Werner, E, et al. Central-line–associated bloodstream infections in pediatric hematology-oncology patients with different types of central lines. Pediatr Blood Cancer 2016;63:1603–1607.CrossRefGoogle ScholarPubMed
Cecinati, V, Brescia, L, Tagliaferri, L, Giordano, P, Esposito, S. Catheter-related infections in pediatric patients with cancer. Eur J Clin Microbiol Infect Dis 2012;31:2869–2877.CrossRefGoogle ScholarPubMed
Getz, KD, Szymczak, JE, Li, Y, et al. Medical outcomes, quality of life, and family perceptions for outpatient vs inpatient neutropenia management after chemotherapy for pediatric acute myeloid leukemia. JAMA Netw Open 2021;4:e2128385.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. Bloodstream infection event (central-line–associated bloodstream infection and non–central-line–associated bloodstream infection). Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Published 2021. Accessed April 11, 2021.Google Scholar
Gamis, AS, Howells, WB, DeSwarte-Wallace, J, Feusner, JH, Buckley, JD, Woods, WG. Alpha hemolytic streptococcal infection during intensive treatment for acute myeloid leukemia: a report from the children’s cancer group study CCG-2891. J Clin Oncol 2000;18:1845–1855.CrossRefGoogle Scholar
Sung, L, Buxton, A, Gamis, A, Woods, WG, Alonzo, TA. Life-threatening and fatal infections in children with acute myeloid leukemia: a report from the Children’s Oncology Group. J Pediatr Hematol Oncol 2012;34:e30–e35.CrossRefGoogle ScholarPubMed
Lim, MY, Al-Kali, A, Ashrani, AA, et al. Comparison of complication rates of Hickman((R)) catheters versus peripherally inserted central catheters in patients with acute myeloid leukemia undergoing induction chemotherapy. Leuk Lymphoma 2013;54:1263–1267.CrossRefGoogle Scholar
Orgel, E, Ji, L, Pastor, W, Schore, RJ. Infectious morbidity by catheter type in neutropenic children with cancer. Pediatr Infect Dis J 2014;33:263–266.CrossRefGoogle ScholarPubMed
Worth, LJ, Seymour, JF, Slavin, MA. Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Support Care Cancer 2009;17:811–818.CrossRefGoogle ScholarPubMed
Allen, RC, Holdsworth, MT, Johnson, CA, et al. Risk determinants for catheter-associated blood stream infections in children and young adults with cancer. Pediatr Blood Cancer 2008;51:53–58.CrossRefGoogle ScholarPubMed
Doganis, D, Asmar, B, Yankelevich, M, Thomas, R, Ravindranath, Y. Predictive factors for blood stream infections in children with cancer. Pediatr Hematol Oncol 2013;30:403–415.CrossRefGoogle ScholarPubMed
Fu, AB, Hodgman, EI, Burkhalter, LS, Renkes, R, Slone, T, Alder, AC. Long-term central venous access in a pediatric leukemia population. J Surg Res 2016;205:419–425.CrossRefGoogle Scholar
Yacobovich, J, Ben-Ami, T, Abdalla, T, et al. Patient and central venous catheter–related risk factors for blood stream infections in children receiving chemotherapy. Pediatr Blood Cancer 2015;62:471–476.CrossRefGoogle ScholarPubMed
Fratino, G, Molinari, AC, Parodi, S, et al. Central venous catheter–related complications in children with oncological-hematological diseases: an observational study of 418 devices. Ann Oncol 2005;16:648–654.CrossRefGoogle ScholarPubMed
Penel, N, Neu, JC, Clisant, S, Hoppe, H, Devos, P, Yazdanpanah, Y. Risk factors for early catheter-related infections in cancer patients. Cancer 2007;110:1586–1592.CrossRefGoogle ScholarPubMed
Sung, L, Zaoutis, T, Ullrich, NJ, et al. Children’s Oncology Group’s 2013 blueprint for research: cancer control and supportive care. Pediatr Blood Cancer 2013;60:1027–1030.CrossRefGoogle ScholarPubMed
Esbenshade, AJ, Zhao, Z, Baird, A, et al. Prospective Implementation of a risk prediction model for bloodstream infection safely reduces antibiotic usage in febrile pediatric cancer patients without severe neutropenia. J Clin Oncol 2020;38:3150–3160.CrossRefGoogle ScholarPubMed
Fisher, BT, Westling, T, Boge, CLK, et al. Prospective evaluation of galactomannan and (1-->3) beta-d-glucan assays as diagnostic tools for invasive fungal disease in children, adolescents, and young adults with acute myeloid leukemia receiving fungal prophylaxis. J Pediatr Infect Dis Soc 2021;10:864–871.CrossRefGoogle Scholar
Dix, D, Cellot, S, Price, V, et al. Association between corticosteroids and infection, sepsis, and infectious death in pediatric acute myeloid leukemia (AML): results from the Canadian infections in AML research group. Clin Infect Dis 2012;55:1608–1614.CrossRefGoogle ScholarPubMed
Alexander, S, Fisher, BT, Gaur, AH, et al. Effect of levofloxacin prophylaxis on bacteremia in children with acute leukemia or undergoing hematopoietic stem cell transplantation: a randomized clinical trial. JAMA 2018;320:995–1004.CrossRefGoogle ScholarPubMed
Feusner, J. Routine chest radiography for pediatric oncology patients with febrile neutropenia: is it really necessary? Cancer 1997;80:1009–1010.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Adler, A, Yaniv, I, Steinberg, R, et al. Infectious complications of implantable ports and Hickman catheters in paediatric haematology-oncology patients. J Hosp Infect 2006;62:358–365.CrossRefGoogle ScholarPubMed
Hashimoto, Y, Fukuta, T, Maruyama, J, Omura, H, Tanaka, T. Experience of peripherally inserted central venous catheter in patients with hematologic diseases. Intern Med 2017;56:389–393.CrossRefGoogle ScholarPubMed
Hatakeyama, N, Hori, T, Yamamoto, M, et al. An evaluation of peripherally inserted central venous catheters for children with cancer requiring long-term venous access. Int J Hematol 2011;94:372–377.CrossRefGoogle ScholarPubMed
Refaei, M, Fernandes, B, Brandwein, J, Goodyear, MD, Pokhrel, A, Wu, C. Incidence of catheter-related thrombosis in acute leukemia patients: a comparative, retrospective study of the safety of peripherally inserted vs. centrally inserted central venous catheters. Ann Hematol 2016;95:2057–2064.CrossRefGoogle ScholarPubMed
Supplementary material: File

Elgarten et al. supplementary material

Elgarten et al. supplementary material

Download Elgarten et al. supplementary material(File)
File 188.8 KB