Severe neutropenia at time of port insertion is not a risk factor for catheter‐associated infections in children with acute lymphoblastic leukemia

Abstract

BACKGROUND:The objective of this study was to determine whether severe neutropenia on the day of port-a-catheter (PORT) insertion was a risk factor for catheter-associated infection (CAI) in children with acute lymphoblastic leukemia (ALL). METHODS: This was a retrospective study of children with ALL who had a PORT insertion between January 2005 and August 2008. Early ( 30 days) and late (>30 days) postprocedure complications were reviewed. The length of follow-up ranged between 7 months and 42 months. RESULTS: In total, 192 PORTs were inserted in 179 children. There were 43 CAIs (22%), and the infection rate was 0.35 per 1000 catheter-days. The CAI rate (15%) in children who had severe neutropenia on the day of the procedure did not differ statistically from the CAI rate (24%) in children who did not have severe neutropenia (P ¼ .137). Conversely, patients with severe neutropenia who had a CAI were more likely to have their PORT removed (P ¼ .019). The most common organisms to cause catheter removal were coagulase-negative Staphylococcus and Staphylococcus aureus. Patients with high-risk ALL had a statistically significant higher incidence of late CAI than patients with standard-risk ALL (P ¼ .012). Age (P ¼ .272), positive blood culture preprocedure (P ¼ 1.0), and dexamethasone use (P ¼ .201) were not risk factors for CAI. Patients who had an early CAI did not have a greater chance of having a late CAI. The catheter infection-free survival rate at 1 year was 88.6%. CONCLUSIONS: The current results indicated that severe neutropenia on the day of PORT insertion does not increase the risk of CAI in children with ALL. Cancer 2010;116:4368-75.

Totally Implantable Venous Access Devices in Children Requiring Long-Term Chemotherapy: Analysis of Outcome in 122 Children from a Single Institution.

“…The complication of port site infection and hematoma were noted in children with hematological malignancy (2 / 77 v/s 1/ 49). Similar findings were reported by in these series [9][10][11].…”

“…This is related to the degree of neutropenia and thrombocytopenia seen in these children prior to induction chemotherapy. Many investigators have evaluated the utility of TIVAD in children with hematological malignancy [9][10][11]. In our series 61 % of our cases had hematological malignancy.…”

Safety of central venous catheter placement at diagnosis of acute lymphoblastic leukemia in children

“…We did not find a statistically increased risk of infection in patients who were neutropenic at the time of catheter placement (14.2% vs. 6.8%; P = 0.12). Other authors had also shown that an ANC <500/mm 3 on the day of CV insertion is not a risk factor [18]. …”

Faktor Risiko Terjadinya Demam Neutropenia pada Anak Leukemia Limfoblastik Akut

“…Namun, proporsi semakin menurun hingga 0,6 kasus per 1000 hari pemasangan infus (95%CI=0,3-1,2) kejadian infeksi. Penelitian oleh Junqueira 26 mengatakan bahwa demam neutropenia tidak meningkatkan risiko untuk terjadinya infeksi bakteri terkait dengan kateter.…”