TY - JOUR
T1 - Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children
T2 - A propensity score-matched analysis
AU - Cunningham, Aaron J.
AU - McClellan, Kristen V.
AU - Dewey, Elizabeth
AU - Krishnaswami, Sanjay
AU - Butler, Marilyn W.
AU - Nolt, Dawn
AU - Fialkowski, Elizabeth
AU - Haag, Meredith C.
AU - Hamilton, Nicholas A.
N1 - Funding Information:
We would like to acknowledge Rosa Speranza, BS, Brandy Gonzales, BS and the pediatric surgery faculty at Doernbecher and Randall Children's Hospitals for their participation in the study. This study was exempted from obtaining individual patient consent as approved by the Oregon Health & Science University and Legacy Emanuel Hospital Institutional Review Boards. This report does not contain any personal information that could lead to identification of any patients. This research did not receive any specific funding or grant support from agencies in the public, commercial, or not-for-profit sectors. All authors attest that they meet the current ICMJE criteria for Authorship. The following authors have no financial disclosures: AJC, KVM, ED, SK, MWB, DN, MCH, NAH. Funding Sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2019 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - Background: The infectious risk of central venous line (CVL) placement in children with neutropenia (absolute neutrophil count [ANC] < 500/mm3) is not well defined. This study aims to investigate the early (≤ 30 days) and late (> 30 days) infectious complications of CVLs placed in pediatric patients with and without neutropenia. Methods: A retrospective review was conducted of all CVLs placed by pediatric surgeons at two institutions from 2010 to 2017. Multivariable logistic regression was performed to identify risk factors for line infection. Propensity score-matched cohorts of patients with and without neutropenia were compared in a 1:1 ratio. Wilcoxon rank-sum, Chi-square, Fisher's exact, and log-rank tests were also performed. Results: Review identified 1,102 CVLs placed in 937 patients. Fifty-four patients were neutropenic at the time of placement. Multivariable analysis demonstrated tunneled catheters and subclavian access as associated with line infection. The propensity score-matched cohort included 94 patients, 47 from each group. Demographic and preoperative data were similar between the groups (p > 0.05). Patients with neutropenia were no more likely to develop early (4.3% vs. 2.1%, p = 1.000) or late (19.1% vs. 17.0%, p = 1.000) infectious complications than patients without neutropenia, with similar median time to infection (141 vs. 222 days, p = 0.370). Conclusion: A policy of selective CVL placement in neutropenic patients with standardized postoperative line maintenance is safe. Future directions include defining criteria by which neutropenic patients could be prospectively selected for safe CVL placement. Level of Evidence: II – Retrospective cohort study.
AB - Background: The infectious risk of central venous line (CVL) placement in children with neutropenia (absolute neutrophil count [ANC] < 500/mm3) is not well defined. This study aims to investigate the early (≤ 30 days) and late (> 30 days) infectious complications of CVLs placed in pediatric patients with and without neutropenia. Methods: A retrospective review was conducted of all CVLs placed by pediatric surgeons at two institutions from 2010 to 2017. Multivariable logistic regression was performed to identify risk factors for line infection. Propensity score-matched cohorts of patients with and without neutropenia were compared in a 1:1 ratio. Wilcoxon rank-sum, Chi-square, Fisher's exact, and log-rank tests were also performed. Results: Review identified 1,102 CVLs placed in 937 patients. Fifty-four patients were neutropenic at the time of placement. Multivariable analysis demonstrated tunneled catheters and subclavian access as associated with line infection. The propensity score-matched cohort included 94 patients, 47 from each group. Demographic and preoperative data were similar between the groups (p > 0.05). Patients with neutropenia were no more likely to develop early (4.3% vs. 2.1%, p = 1.000) or late (19.1% vs. 17.0%, p = 1.000) infectious complications than patients without neutropenia, with similar median time to infection (141 vs. 222 days, p = 0.370). Conclusion: A policy of selective CVL placement in neutropenic patients with standardized postoperative line maintenance is safe. Future directions include defining criteria by which neutropenic patients could be prospectively selected for safe CVL placement. Level of Evidence: II – Retrospective cohort study.
KW - Bloodstream infection
KW - Central line
KW - Neutropenia
KW - Propensity score-matching
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U2 - 10.1016/j.jpedsurg.2019.08.005
DO - 10.1016/j.jpedsurg.2019.08.005
M3 - Article
C2 - 31515110
AN - SCOPUS:85071987261
VL - 55
SP - 1339
EP - 1343
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 7
ER -