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

• Published in: Cancer 2010-09, Vol.116 (18), p.4368-4375
• Main Authors: Junqueira, Beatriz L. P., Connolly, Bairbre, Abla, Oussama, Tomlinson, George, Amaral, Joao G.
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Adolescent; Biological and medical sciences; Blood culture; Cancer; Catheter-Related Infections - epidemiology; Catheters; Catheters, Indwelling - adverse effects; catheter‐associated infection; Child; Child, Preschool; Children; Coagulase; complications; Dexamethasone; Female; Hematologic and hematopoietic diseases; Humans; Incidence; Infant; infection; Infections; Insertion; Leukemia; Lymphatic leukemia; Male; Medical instruments; Medical sciences; Neutropenia; Neutropenia - complications; Other diseases. Hematologic involvement in other diseases; Port‐a‐catheter; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Reviews; Risk Factors; severe neutropenia; Staphylococcus aureus; Statistical analysis; Survival; Tumors; wound dehiscence
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.25286

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 = .137). Conversely, patients with severe neutropenia who had a CAI were more likely to have their PORT removed (P = .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 = .012). Age (P = .272), positive blood culture preprocedure (P = 1.0), and dexamethasone use (P = .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. © 2010 American Cancer Society. Severe neutropenia on the day of port‐a‐catheter insertion did not increase the risk of catheter‐associated infections in children with newly diagnosed acute lymphoblastic leukemia (ALL). High‐risk precursor B‐cell and T‐cell ALL were identified as risk factors for late catheter‐associated infections.