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

Illya Martynov,Joachim Schoenberger

doi:10.3389/fonc.2021.770698

Abstract

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.

Highlights

Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are the two most common types of acute childhood leukemias accounting for approximately 30% of all pediatric malignancies [1]
We identified female sex (HR 2.640, p = 0.006) and the use of tunneled central venous catheter (TCVC) for treatment of relapsed leukemia (HR 4.347, p < 0.0001) as risk factors for early central line-associated bloodstream infections (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
The literature is inconsistent regarding the association of perioperative neutropenia and increased incidence of catheter exit-site infections (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 in the setting of neutropenia [9,10,11]

Summary

Introduction

Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are the two most common types of acute childhood leukemias accounting for approximately 30% of all pediatric malignancies [1]. TCVCs are often associated with infective events, including local catheter exit-site infections (CESI) and central line-associated bloodstream infections (CLABSI). As pediatric patients with hematooncological diseases often present with neutropenia (absolute neutrophil count [ANC]

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