Central Venous Catheters and Bloodstream Infection During Induction Therapy in Children With Acute Lymphoblastic Leukemia

Bergmann, Kristin; Hasle, Henrik; Asdahl, Peter H.; Handrup, Mette Møller; Wehner, Peder Skov; Rosthøj, Steen

doi:10.1097/mph.0000000000000519

Cited by 13 publications

(19 citation statements)

References 16 publications

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“…Nevertheless, comparisons are limited by differences in chemotherapy protocols, antimicrobial prophylaxis regimens and definitions of reported outcomes. In our study, bacteraemia occurred after a median of 2 weeks from start of chemotherapy, as reported by other studies in ALL induction treatment, 26,28,29 coinciding with the time point of maximum enterocyte loss and neutropaenia. Nevertheless, plasma citrulline level on day 15 was significantly lower in patients with bacteraemia compared to patients without, while ANC did not differ significantly between the two groups.…”

Section: Discussionsupporting

confidence: 87%

“…The majority of microorganisms isolated in blood cultures were gram‐positive bacteria, which is in line with previous studies in children with ALL receiving induction treatment 25,26,28,29 and in paediatric oncological patients in general 37–39 . A third of positive isolates were represented by coagulase‐negative staphylococci (CoNS).…”

Section: Discussionsupporting

confidence: 86%

“…31 Moreover, a recent study using nontargeted metabolomic analyses has identified citrulline as a marker of bacteraemia or sepsis in haematological patients with febrile neutropaenia. 36 At The majority of microorganisms isolated in blood cultures were gram-positive bacteria, which is in line with previous studies in children with ALL receiving induction treatment 25,26,28,29 and in paediatric oncological patients in general. [37][38][39] A third of positive isolates were represented by coagulase-negative staphylococci (CoNS).…”

Section: F I G U R Esupporting

confidence: 88%

“…The incidence of bacteraemia around 30% in this study corresponds to the incidence of bloodstream infections (BSI) previously reported in Denmark during NOPHO ALL-2008 or earlier NOPHO induction protocols with similar trimethoprim-sulfamethoxazole prophylaxis. 25,26 The incidence of bacteraemia or BSI during ALL induction treatment has been reported between 10% and 45% in other studies from high-income countries. 3,[27][28][29] Nevertheless, comparisons are limited…”

Section: Discussionmentioning

confidence: 99%

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Citrulline as a biomarker of bacteraemia during induction treatment for childhood acute lymphoblastic leukaemia

Pietri

Frandsen

Christensen

et al. 2020

Pediatric Blood & Cancer

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Background: Systemic infections are a major cause of morbidity in children with acute lymphoblastic leukaemia (ALL). However, identification of patients at increased risk is still a challenge. Knowing that both neutropaenia and gastrointestinal toxicity are risk factors for bacteraemia, we aimed at comparing absolute neutrophil counts (ANC) and plasma citrulline levels (indicating enterocyte loss) in children with ALL with and without bacteraemia during induction treatment. Procedure: We prospectively included 61 children with ALL treated according to the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-2008 protocol. ANC and plasma C-reactive protein (CRP) were measured on treatment days 1, 8, 15, 22 and 29. Plasma citrulline was measured on days 1, 8, 15 and 29. Bacteraemia episodes during induction treatment were recorded retrospectively. Results: Nineteen of sixty-one (31%) patients experienced bacteraemia occurring on median day 13 (range 5-20). Patients with bacteraemia during induction treatment had lower citrulline level on day 15 (P < .01) compared to patients without bacteraemia, indicating more severe enterocyte loss. Nevertheless, ANC was similar in the two patient groups on days 8 and 15. CRP was negatively correlated with same-day citrulline (P < .03 for all) and ANC (P < .04 for all). Conclusions: During chemotherapy-induced neutropaenia, plasma citrulline may help identify patients at increased risk of bacteraemia.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 86%

Section: F I G U R Esupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Citrulline as a biomarker of bacteraemia during induction treatment for childhood acute lymphoblastic leukaemia

Pietri

Frandsen

Christensen

et al. 2020

Pediatric Blood & Cancer

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“…However, the incidence of positive microbiological detection by BC tests has been low. Importantly, the spectrum of pathogens detected by the BC test has changed with the time depending on various factors, such as types of prophylactic agents, the usage of either a Central Venous Catheter (CVC) or external lines, BSI recurrence, and types of treatment for the primary hematologic diseases [6][7][8] . Indeed, the most prevalent causative microorganisms were Gram-negative species, such as Pseudomonas aeruginosa or Escherichia coli, from the 1970's to the late 1980's.…”

Section: Introductionmentioning

confidence: 99%

High Frequencies of Drug-resistant Pathogens in Blood Stream Infections Associated with Hematologic Disorders: Five-year single institutional surveillance from 2010 to 2014

Kobayashi¹,

Tsukamoto²,

Maegawa³

et al. 2017

IJHT

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In order to improve the management of infectious complications associated with hematologic disorders, we conducted a retrospective 5-year analysis of Blood Culture (BC) tests obtained from febrile patients with hematological disorders treated in our institute between 2010 and 2014. BCs were performed using the BacT/ALERT 3D system (bioMérieux, Marcy l'Etoile, France) and identification and antibiotic susceptibility testing were performed using VITEK2 (bioMérieux). In 8,549 BC tests obtained from 1,517 febrile events, 325 BC tests showed positive results in 154 febrile episodes with 91 patients. In BC-positive episodes, the incidence of BC-positivity for 3 consecutive BC tests per febrile episode was 98.1 %. The frequencies of Gram-positive and Gram-negative bacteria as the causative pathogen were almost equal (44.5 % vs 43.3 %). The frequency of drug-resistant bacteria, such as either methicillin-resistant cocci or extended spectrum beta-lactamase producing organism, was more than 50 %. The use of a central venous catheter showed a positive relationship with the methicillin-resistant cocci in our series. Our study found increasing frequencies of drug-resistant bacteria as the pathogens of blood stream infection in hematological disorders. These results are instructive for the appropriate selection of empiric antibiotic therapy for febrile events in patients with hematologic malignancies.

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Gastrointestinal barrier integrity and mucosal inflammation as risk factors of blood stream infections in children treated for acute lymphoblastic leukaemia

Pietri

Weischendorff

Rathe

et al. 2023

Intl Journal of Cancer

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Chemotherapy‐induced mucositis increases the risk of blood stream infections (BSI) due to translocation of bacteria across the intestinal epithelium. Our study investigated if quantitative measures of intestinal mucositis severity, including plasma citrulline (a marker of functional enterocytes) and CCL20 (an intestinal immune homeostatic chemokine), could identify patients at risk of BSI. A total of 106 children with ALL undergoing induction treatment (NOPHO ALL 2008) were included and information regarding BSI episodes was collected from the patients' medical records. Twenty‐seven patients (25%) developed BSI during induction. Patients with BSI had a larger decrease in citrulline after chemotherapy than patients without BSI, and nearly all BSI episodes (25/27) occurred in the group of patients exhibiting a drop in citrulline (OR = 6.4 [95% CI: 1.4‐29.3], P = .008). Patients who developed BSI had higher plasma CCL20 levels on days 8, 15 and 22 than patients without BSI (all P < .05), and elevated CCL20 levels on day 8 increased the risk of subsequent BSI (OR = 1.57 [1.11‐2.22] per doubling of CCL20 level, P = .01) in a multivariable logistic regression analysis. These findings suggest that children with ALL who develop BSI during chemotherapy are characterised by more severe intestinal mucositis, as measured by plasma citrulline and CCL20. These markers may be useful in early risk stratification to guide treatment decisions.

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Central Venous Catheters and Bloodstream Infection During Induction Therapy in Children With Acute Lymphoblastic Leukemia

Cited by 13 publications

References 16 publications

Citrulline as a biomarker of bacteraemia during induction treatment for childhood acute lymphoblastic leukaemia

Citrulline as a biomarker of bacteraemia during induction treatment for childhood acute lymphoblastic leukaemia

High Frequencies of Drug-resistant Pathogens in Blood Stream Infections Associated with Hematologic Disorders: Five-year single institutional surveillance from 2010 to 2014

Gastrointestinal barrier integrity and mucosal inflammation as risk factors of blood stream infections in children treated for acute lymphoblastic leukaemia

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