Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia

Caitlin W. Elgarten; William R. Otto; Luke Shenton; Madison T. Stein; Joseph Horowitz; Catherine Aftandilian; Staci D. Arnold; Kira O. Bona; Emi Caywood; Anderson B. Collier; M. Monica Gramatges; Meret Henry; Craig Lotterman; Kelly Maloney; Arunkumar J. Modi; Amir Mian; Rajen Mody; Elaine Morgan; Elizabeth A. Raetz; Anupam Verma; Naomi Winick; Jennifer J. Wilkes; Jennifer C. Yu; Richard Aplenc; Brian T. Fisher; Kelly D. Getz

doi:10.1017/ice.2022.82

Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia

Caitlin W. Elgarten^*, William R. Otto, Luke Shenton, Madison T. Stein, Joseph Horowitz, Catherine Aftandilian, Staci D. Arnold, Kira O. Bona, Emi Caywood, Anderson B. Collier, M. Monica Gramatges, Meret Henry, Craig Lotterman, Kelly Maloney, Arunkumar J. Modi, Amir Mian, Rajen Mody, Elaine Morgan, Elizabeth A. Raetz, Anupam VermaNaomi Winick, Jennifer J. Wilkes, Jennifer C. Yu, Richard Aplenc, Brian T. Fisher, Kelly D. Getz

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English (US)
Pages (from-to)	222-229
Number of pages	8
Journal	Infection Control and Hospital Epidemiology
Volume	44
Issue number	2
DOIs	https://doi.org/10.1017/ice.2022.82
State	Published - Feb 25 2023

Funding

BTF receives research funding from Pfizer and Merck. He also serves as on a data safety monitoring board for Astellas. All other authors report no conflicts of interest relevant to this article. This research was supported by the Patient Centered Outcomes Research Institute (grant no. CER-1409-22827). Dr. William Otto’s effort on his project was supported in part by a NICHD Training Award (grant no. T32 HD043021). Dr. Kelly Getz’s effort on this project was supported in part by a NHLBI Career Development Award (grant no. 1K01HL143153). The content of this publication does not necessarily reflect the views of policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.

ASJC Scopus subject areas

Epidemiology
Microbiology (medical)
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1017/ice.2022.82

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Elgarten, C. W., Otto, W. R., Shenton, L., Stein, M. T., Horowitz, J., Aftandilian, C., Arnold, S. D., Bona, K. O., Caywood, E., Collier, A. B., Gramatges, M. M., Henry, M., Lotterman, C., Maloney, K., Modi, A. J., Mian, A., Mody, R., Morgan, E., Raetz, E. A., ... Getz, K. D. (2023). Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia. Infection Control and Hospital Epidemiology, 44(2), 222-229. https://doi.org/10.1017/ice.2022.82

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title = "Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia",

abstract = "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.",

author = "Elgarten, {Caitlin W.} and Otto, {William R.} and Luke Shenton and Stein, {Madison T.} and Joseph Horowitz and Catherine Aftandilian and Arnold, {Staci D.} and Bona, {Kira O.} and Emi Caywood and Collier, {Anderson B.} and Gramatges, {M. Monica} and Meret Henry and Craig Lotterman and Kelly Maloney and Modi, {Arunkumar J.} and Amir Mian and Rajen Mody and Elaine Morgan and Raetz, {Elizabeth A.} and Anupam Verma and Naomi Winick and Wilkes, {Jennifer J.} and Yu, {Jennifer C.} and Richard Aplenc and Fisher, {Brian T.} and Getz, {Kelly D.}",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.",

year = "2023",

month = feb,

day = "25",

doi = "10.1017/ice.2022.82",

language = "English (US)",

volume = "44",

pages = "222--229",

journal = "Infection Control and Hospital Epidemiology",

issn = "0899-823X",

publisher = "Cambridge University Press",

number = "2",

}

Elgarten, CW, Otto, WR, Shenton, L, Stein, MT, Horowitz, J, Aftandilian, C, Arnold, SD, Bona, KO, Caywood, E, Collier, AB, Gramatges, MM, Henry, M, Lotterman, C, Maloney, K, Modi, AJ, Mian, A, Mody, R, Morgan, E, Raetz, EA, Verma, A, Winick, N, Wilkes, JJ, Yu, JC, Aplenc, R, Fisher, BT & Getz, KD 2023, 'Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia', Infection Control and Hospital Epidemiology, vol. 44, no. 2, pp. 222-229. https://doi.org/10.1017/ice.2022.82

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.

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.

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U2 - 10.1017/ice.2022.82

DO - 10.1017/ice.2022.82

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AN - SCOPUS:85129691406

SN - 0899-823X

VL - 44

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EP - 229

JO - Infection Control and Hospital Epidemiology

JF - Infection Control and Hospital Epidemiology

IS - 2

ER -

Risk of bacterial bloodstream infection does not vary by central-line type during neutropenic periods in pediatric acute myeloid leukemia

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UN SDGs

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