Comparing catheter‐related bloodstream infections in pediatric and adult cancer patients

Zakhour, Ramia; Hachem, Ray; Hussain, Alawami; Jiang, Ying; Michael, Majd; Chaftari, Anne-Marie; Raad, Issam

doi:10.1002/pbc.26537

Cited by 11 publications

(8 citation statements)

References 18 publications

(20 reference statements)

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“…A third of positive isolates were represented by coagulase‐negative staphylococci (CoNS). CoNS bacteraemia is usually assumed to derive from CVC contamination with CoNS colonising the skin 38 . Nevertheless, there is evidence suggesting that CoNS also reside in the gastrointestinal tract and can translocate into the bloodstream causing bacteraemia 40 .…”

Section: Discussionmentioning

confidence: 99%

“…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). CoNS bacteraemia is usually assumed to derive from CVC contamination with CoNS colonising the skin.…”

Section: F I G U R Ementioning

confidence: 99%

“…CoNS bacteraemia is usually assumed to derive from CVC contamination with CoNS colonising the skin. 38 Nevertheless, there is evidence suggesting that CoNS also reside in the gastrointestinal tract and can translocate into the bloodstream causing bacteraemia. 40 In patients undergoing HSCT, CoNS and oral viridans streptococci bacteraemia have been reported to coincide with increased gut permeability and to occur more frequently following conditioning regimens with high intestinal toxicity.…”

Section: F I G U R Ementioning

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: Discussionmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

See 1 more Smart Citation

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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“…Therefore, the Infectious Diseases Society of America (IDSA) guidelines strongly recommend catheter removal in case of S. aureus CRBSI or CLABSI in adults, and treating with intravenous (iv) adequate antibiotic therapy for at least 14 days (8). Pediatricians are however often tempted to avoid catheter removal because of the inconvenience of catheter replacement in children, such as risks of general anesthesia, difficulties of vascular access, and the risk of relapse of a CLABSI on the new catheter (9). Thus, IDSA guidelines leave the possibility to keep the CVC in pediatric cases of catheter-related infection if there are “unusual extenuating circumstances” by using combined systemic antibiotics and antibiotic lock therapy (8).…”

Section: Introductionmentioning

confidence: 99%

Salvage Strategy for Long-Term Central Venous Catheter-Associated Staphylococcus aureus Infections in Children

et al. 2019

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Introduction: Current international guidelines strongly recommend catheter removal in case of S. aureus central line-associated bloodstream infection (CLASBI), but a catheter salvage strategy may be considered in children given age-related specificities. No data is available regarding the outcome of this strategy in children. This study aims to evaluate catheter salvage strategy in children with S. aureus CLABSI, and to determine treatment failure rates and associated risk factors.Methods: We retrospectively analyzed data for all children <18 years having S. aureus CLABSI on a long-term central venous catheter in a tertiary hospital from 2010 to 2014. We defined catheter salvage strategy as a central venous catheter left in place ≥3 days after initiation of empiric treatment for suspected bacteremia, and catheter salvage strategy failure as the persistence or relapse of bacteremia with a S. aureus strain harboring the same antibiotic susceptibility pattern, or the occurrence or the worsening of local or systemic infectious complication between 72 h and 28 days after the first positive blood culture.Results: During the study period, 49 cases of S. aureus CLABSI on long-term central venous catheters were observed in 41 children (including 59% with long-term parenteral nutrition) and 6 (15%) isolates were resistant to methicillin. A catheter salvage strategy was chosen in 37/49 (76%) cases and failed in 12/37 (32%) cases. Initial presence of bloodstream co-infection, serum concentration of vancomycin under the targeted value and inadequate empiric treatment were significantly associated with catheter salvage therapy failure.Conclusions: The catheter salvage strategy of S. aureus CLABSI on a long-term central venous catheter was frequent in the studied hospital and failed only in one third of cases.

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“…Studies incorporating different patient populations were only included if the text outlined that patients on parenteral nutrition were included. Studies only containing children were excluded in order to limit the heterogeneity of the patient population and because of expected differences in CRBSI etiology, diagnosis, and management ( 22 , 23 ). When distinct publications had partly overlapping data due to the same patients’ inclusion, the results were either combined or collected from the most extensive study to avoid duplicate data.…”

Section: Methodsmentioning

confidence: 99%

Comparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysis

Gompelman

Paus

Bond

et al. 2021

The American Journal of Clinical Nutrition

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Background Catheter-related bloodstream infection (CRBSI) is a life-threatening complication of parenteral nutrition. Therefore, optimal management, ideally with catheter salvage, is required to maintain long-term venous access. Objectives We aimed to evaluate successful catheter salvage rates in patients on home parenteral nutrition (HPN). Methods Studies were retrieved from medical databases, conference proceedings, and article reference lists. Data were collected relating to clinical outcomes of 3 treatments: systemic antibiotics, antimicrobial lock therapy (ALT), and catheter exchange. ORs and 95% CIs were calculated from a mixed logistic effects model. Results From 10,036 identified publications, 28 met the inclusion criteria (22 cohort studies, 5 case-control studies, and 1 randomized clinical trial), resulting in a total of 4911 CRBSIs. To achieve successful catheter salvage, the addition of an antimicrobial lock solution was superior to systemic antibiotics alone (OR: 1.75; 95% CI: 1.21, 2.53; P = 0.003). Recurrence of infection was less common in studies that used ALT than in those that used systemic antibiotics alone (OR: 0.26; 95% CI: 0.11, 0.61; P = 0.002). The catheter exchange group was excluded from multilevel regression analysis because only 1 included study applied this treatment. Successful salvage rates were highest for coagulase-negative staphylococci, followed by Gram-negative rods and Staphylococcus aureus . Conclusions The addition of an antimicrobial lock solution seems beneficial for successful catheter salvage in HPN-dependent patients with a CRBSI. Future prospective randomized studies should identify the most effective and pathogen-specific strategy. This review was registered at www.crd.york.ac.uk/PROSPERO as CRD42018102959.

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Comparing catheter‐related bloodstream infections in pediatric and adult cancer patients

Cited by 11 publications

References 18 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

Salvage Strategy for Long-Term Central Venous Catheter-Associated Staphylococcus aureus Infections in Children

Comparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysis

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