TY - JOUR
T1 - Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia
AU - Elgarten, Caitlin W.
AU - Otto, William R.
AU - Shenton, Luke
AU - Stein, Madison T.
AU - Horowitz, Joseph
AU - Aftandilian, Catherine
AU - Arnold, Staci D.
AU - Bona, Kira O.
AU - Caywood, Emi
AU - Collier, Anderson B.
AU - Gramatges, M. Monica
AU - Henry, Meret
AU - Lotterman, Craig
AU - Maloney, Kelly
AU - Modi, Arunkumar J.
AU - Mian, Amir
AU - Mody, Rajen
AU - Morgan, Elaine
AU - Raetz, Elizabeth A.
AU - Verma, Anupam
AU - Winick, Naomi
AU - Wilkes, Jennifer J.
AU - Yu, Jennifer C.
AU - Aplenc, Richard
AU - Fisher, Brian T.
AU - Getz, Kelly D.
N1 - Publisher Copyright:
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
PY - 2023/2/25
Y1 - 2023/2/25
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85129691406&partnerID=8YFLogxK
U2 - 10.1017/ice.2022.82
DO - 10.1017/ice.2022.82
M3 - Article
C2 - 35465865
AN - SCOPUS:85129691406
SN - 0899-823X
VL - 44
SP - 222
EP - 229
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 2
ER -