Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children: A propensity score-matched analysis

Cunningham, Aaron J.; McClellan, Kristen; Dewey, Elizabeth; Krishnaswami, Sanjay; Butler, Marilyn; Nolt, Dawn; Fialkowski, Elizabeth; Haag, Meredith B.; Hamilton, Nicholas A.

doi:10.1016/j.jpedsurg.2019.08.005

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“…Consequently, some centers recommend TCVC placement only with ANC higher than 0.5 × 10 9 /L or even 1.0 × 10 9 /L. However, the literature is inconsistent regarding the association of perioperative neutropenia and increased incidence of CESI/ CLABSI, with other studies showing no significant differences of CESI/CLABSI rates in neutropenic compared to nonneutropenic children at the time of catheter placement, indicating the safety of TCVC implantation also in the setting of neutropenia (9)(10)(11). Finally, most of the previous studies investigate the association between perioperative ANC and TCVC-associated infective complications in heterogeneous patient populations, which differ at baseline risk for CLABSI (12).…”

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confidence: 99%

Impact of Perioperative Absolute Neutrophil Count on Central Line-Associated Bloodstream Infection in Children With Acute Lymphoblastic and Myeloid Leukemia

Martynov

Schoenberger

2021

Front. Oncol.

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BackgroundThere is lack of evidence concerning safety of placement of tunneled central venous catheters (TCVCs) in neutropenic children with acute leukemias. Here, we evaluate the impact of absolute neutrophil count (ANC) at the time of TCVC placement on development of central line-associated bloodstream infections (CLABSI) in children with lymphoblastic (ALL) or myeloid leukemia (AML).Materials and MethodsA retrospective observational study of children undergoing TCVC placement at a tertiary referral hospital between January 2000 and December 2019 was performed. Traditional and competing-risks regression models were used to estimate the effect of perioperative ANC on development of CLABSI.ResultsA total of 350 children (median age 6.4 [IQR: 3.1–10.9] years) underwent 498 consecutive TCVC implantations in neutropenic (n = 172, 34.5%) and non-neutropenic conditions (n = 326, 65.5%). The median length of observation per TCVC was 217.1 (IQR: 116.1–260.5) days with a total of 99,681 catheter days (CD). There were no differences in early (within first 30 days after TCVC placement) and overall CLABSI rates between neutropenic and non-neutropenic patients (HR 1.250, p = 0.502; HR 1.633, p = 0.143). We identified female sex (HR 2.640, p = 0.006) and the use of TCVC for treatment of relapsed leukemia (HR 4.347, p < 0.0001) as risk factors for early CLABSI and the use of double-lumen catheters (HR 2.607, p = 0.003) and use of TCVCs during leukemia relapse (HR 2.004, p = 0.005) for overall study period.ConclusionThe placement of TCVC in children with neutropenia undergoing anticancer therapy for acute leukemia is safe and not associated with an elevated rate of CLABSI.

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