Research Activities, September 2013
Pediatric leukemia patients are among the childhood cancer patients most likely to develop central line-associated bloodstream infections when hospitalized
Children with leukemia are the pediatric patients most likely to develop central line-associated bloodstream infections (CLABSIs) when hospitalized, according to a new study. These children accounted for 64 percent of CLABSIs in a population of pediatric hematology-oncology (PHO) patients followed at 36 PHO centers across the United States. Although central venous catheters help medical staff manage patients with bloodstream cancers and other hematologic conditions, their use increases the risk of bloodstream infections such as CLABSIs.
The researchers examined 576 cases of CLABSI in PHO patients reported by members of the Children's Hospital Association during November 2009 through July 2011.
The median time from hospital admission to CLABSI was 14 days (range = 1–411 days). A variety of central venous catheters were used, with 62 children having more than one catheter type. The median patient age was 8 years and 53 percent were boys. Among the 335 CLABSI events in patients with leukemia, 60 percent had acute myeloid leukemia and 35 percent had acute lymphoblastic leukemia.
Most of the CLABSIs (80 percent) occurred in patients with very low absolute neutrophil counts (less than 100 cells/mm3). A single organism was isolated in 88 percent of the events, with 54 percent of these being gram positive—predominantly Viridans streptococci, an organism type not commonly reported causing CLABSI in non-oncology patients, or coagulase-negative staphylococci. Gram-negative bacteria were found in 39 percent of single-organism CLABSIs, with E. coli and Enterobacter cloacae being the most prevalent. This is the first multicenter, contemporary report of prospectively identified CLABSIs in PHO patients in the United States.The study was funded in part by AHRQ (HS19590).
More details are in "Surveillance of hospital-acquired central line-associated bloodstream infections in pediatric hematology-oncology patients: Lessons learned, challenges ahead," by Aditya H. Gaur, M.D., M.Sc., David G. Bundy, M.D., M.P.H., Cuilan Gao, Ph.D., and others in the March 2013 Infection Control and Hospital Epidemiology 34(3), pp. 316-320.