Central line‐associated bloodstream infection in childhood malignancy: Single‐center experience

Miliaraki, Marianna; Katzilakis, Nikolaos; Chranioti, Ioanna; Stratigaki, Maria; Koutsaki, Maria; Psarrou, Maria; Αθανασόπουλος, Ηλίας; Stiakaki, Eftichia

doi:10.1111/ped.13289

Cited by 20 publications

(27 citation statements)

References 27 publications

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“…In the multivariable risk factor analysis, a leukocytopenia proved to be an independent risk factor for CLABSI. This is in line with several other reports that found severe leukocytopenia and neutropenia being relevant risk factors for CLABSI development in adult and pediatric patients with different implanted and non-implanted CVCs [13,[19][20][21]. Leukopenia may correspond to the intensity of therapy and state of disease, in particular in acute leukemia.…”

Section: Discussionsupporting

confidence: 91%

Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

et al. 2020

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Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (� 1000/ μL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.

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Section: Discussionsupporting

confidence: 91%

Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

et al. 2020

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“…5 Healthcare-acquired bloodstream infections (HA-BSIs) are the most common HAIs in critically ill pediatric patients of all age groups because central venous catheters (CVCs) are commonly used in these patients. [6][7][8][9] In the United States, HA-BSIs are associated with the highest number of preventable deaths among HAIs, as well as the highest costs, ranging from $960 million to $18.2 billion annually. 10 Although strong evidence indicates that most HA-BSIs are preventable, 9,[11][12][13][14][15][16] pediatric and neonatal HA-BSI rates remain far above zero in many countries worldwide, highlighting the need to initiate further national and targeted prevention strategies.…”

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confidence: 99%

Length of stay, cost, and mortality of healthcare-acquired bloodstream infections in children and neonates: A systematic review and meta-analysis

Karagiannidou

Triantafyllou

Zaoutis

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs).Design:A systematic review and meta-analysis.Methods:A systematic search (January 2000–September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case–control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated.Results:In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70–20.11) and the pooled attributable mortality rate was 8% (95% CI, 6–9). A meta-analysis was not conducted for cost due to lack of eligible studies.Conclusions:Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.

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“…This is the most common pathogen of bacteremia and reinfection related to central venous carriage (CVC) in studies conducted in other countries as well. This trend is probably because the major microbial flora of the skin comprises staphylococci [[16], [17], [18]]. The organisms present in the skin migrate from the insertion site into the cutaneous catheter tract, thereby resulting in colonization of the tip of the catheter and formation of biofilms [17,19,20].…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of antibiotic lock therapy for bloodstream infections in pediatric hematology/oncology patients in a tertiary care hospital, Karachi, Pakistan

Qureshi

Fatima

Mukhtar

et al. 2019

International Journal of Pediatrics and Adolescent Medicine

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Background Intravascular catheters are susceptible to infections, thus requiring catheter removal and leading to increased morbidity and costs. Antibiotic lock therapy (ALT) is a therapeutic technique that is used to salvage the catheter. The aim of this study was to evaluate the outcome of antibiotic lock therapy in bloodstream infections in pediatric hematology/oncology patients in a tertiary care hospital, Karachi. Methods A retrospective review was performed from January 2013 to December 2017 of pediatric hematology/oncology patients with bloodstream infections and who received ALT at Aga Khan University Hospital. All cases of polymicrobial infections, catheter removal, or malfunction before the completion of ALT were excluded. Descriptive analysis was carried out using SPSS version 20. Results A total of nine hematology/oncology patients were eligible. The catheter was salvaged in 7/9 (77.8%) children, and in 2/9 (22.2%) cases, catheter was removed because of persistent bacteremia. The most common organism isolated was Staphylococcus non-aureus species (33.3%). Relapse with a similar pathogen occurred in 2 (22.2%) patients and 2 (22.2%) of them developed an exit-site infection. Conclusion In our experience, in almost two thirds of the cases, the catheter was salvaged, but disappointingly, relapses were high when the infection was due to Staphylococcus spp. Although this is a small study, our results show that ALT can be a potential safe adjunctive strategy to treat catheter-related bloodstream infections (CRBSI). However, we need larger prospective studies to test the safety and efficacy of ALT to develop specific ALT recommendations and guidelines particularly in children.

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Central line‐associated bloodstream infection in childhood malignancy: Single‐center experience

Abstract: Younger age, neutropenia, hematologic malignancy and longer catheterization are important risk factors for CLABSI, but further research is required for the prevention of catheter-related infection in children with malignancy.

Cited by 20 publications

References 27 publications

Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

Length of stay, cost, and mortality of healthcare-acquired bloodstream infections in children and neonates: A systematic review and meta-analysis

Clinical profile and outcome of antibiotic lock therapy for bloodstream infections in pediatric hematology/oncology patients in a tertiary care hospital, Karachi, Pakistan

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