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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*
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

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
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

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

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