Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia.

TitleRisk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia.
Publication TypeJournal Article
Year of Publication2022
AuthorsElgarten CW, Otto WR, Shenton L, Stein MT, Horowitz J, Aftandilian C, Arnold SD, Bona KO, Caywood E, Collier AB, M Gramatges M, Henry M, Lotterman C, Maloney K, Modi AJ, Mian A, Mody R, Morgan E, Raetz EA, Verma A, Winick N, Wilkes JJ, Yu JC, Aplenc R, Fisher BT, Getz KD
JournalInfect Control Hosp Epidemiol
Pagination1-8
Date Published2022 Apr 25
ISSN1559-6834
Abstract

BACKGROUND: Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.

OBJECTIVE: To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.

METHODS: We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.

RESULTS: The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75-1.32) and TIC IRR = 0.83 (95% CI, 0.49-1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.

CONCLUSIONS: In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.

DOI10.1017/ice.2022.82
Alternate JournalInfect Control Hosp Epidemiol
PubMed ID35465865
Grant ListT32 HD043021 / HD / NICHD NIH HHS / United States