Prospective Surveillance Study of Blood Stream Infections Associated With Central Venous Access Devices (Port-type) in Children With Acute Leukemia

Abstract

The use of intensive chemotherapy and central devices has improved patients survival, but it is associated with catheter-related blood-stream infections (CRBSI). An educational program was instituted for preventing CRBSI occurrence in acute leukemia pediatric patients having totally implanted central devices. The Centers of Disease Control and Prevention criteria were used as definition for CRBSI. Data collected were age, sex, diagnosis, chemotherapy, inpatient versus outpatient, microbiological data, risk factors, social risk score, and treatment performed. CRBSI rate decreased from 6.7 to 3.7/1000 catheter-days with preventive measures (P=0.05). A further decrease to 1.5/1000 catheter-days was reached after the intensification of the educational program (P=0.01). Severe neutropenia at the time of catheter insertion was related to CRBSI and to infection recurrence (P<0.05). Most of the episodes occurred during induction chemotherapy. Thirty-six CRBSI episodes occurred in 25 of 73 patients. The most frequent microorganism isolated was Staphylococcus spp. Antibiotherapy was successful in 83.3% of episodes. Six patients needed a central venous access device replacement. Our intervention program was successful to decrease the CRBSI rates and its intensification allowed a further decrease, approaching reported rates in this setting. Severe neutropenia at the time of central venous access device insertion was related to CRBSI occurrence and recurrence.

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

“…In contrast, they noted a statistically significant increased risk for CLABSI in patients with severe neutropenia at the time of the CVC placement. 22 This is why it has been recommended that CVC placement should be avoided when ANC is <0.5 9 10 9 /L. 1 In the present retrospective study the majority of patients (95%) had a tunneled external (TE) CVC and only two patients (5%) had a totally implantable design, therefore an association between catheter design and risk for CLABSI could not be made.…”

“…showed that ANC was not associated with an increased risk for developing CLABSI. In contrast, they noted a statistically significant increased risk for CLABSI in patients with severe neutropenia at the time of the CVC placement . This is why it has been recommended that CVC placement should be avoided when ANC is <0.5 × 10 9 /L …”

“…In a multicenter surveillance study of CLABSI in children with cancer, 36% (68/191) of the patients were not neutropenic at the time of CLABSI diagnosis . Moreover, Berrueco et al . showed that ANC was not associated with an increased risk for developing CLABSI.…”

“…More intensive chemotherapy regimens seem to be significantly associated with CLABSI in the pediatric oncology group. This is probably related to prolonged and severe myelotoxicity, especially during the first 6 months of chemotherapy, along with the fact that this period requires frequent hospitalizations and CVC procedures …”

“…19 In a multicenter surveillance study of CLABSI in children with cancer, 36% (68/191) of the patients were not neutropenic at the time of CLABSI diagnosis. 21 Moreover, Berrueco et al 22 showed that ANC was not associated with an increased risk for developing CLABSI. In contrast, they noted a statistically significant increased risk for CLABSI in patients with severe neutropenia at the time of the CVC placement.…”