Risk factors for bacteremia and central line–associated blood stream infections in children with acute myelogenous leukemia: A single-institution report

Abstract

Background

Central line–associated blood stream infections (CLABSIs) are a source of high morbidity and mortality in children with acute myelogenous leukemia (AML).

Procedure

To understand the epidemiology and risk factors associated with the development of CLABSI in children with AML.

Methods

We retrospectively reviewed all patients with AML over a 5-year period between 2007 and 2011 at the Children's Hospital Colorado. Cases and controls were classified on the basis of the presence of a CLABSI as defined by the National Healthcare Safety Network.

Results

Of 40 patients in the study, 25 (62.5%) developed at least one CLABSI during therapy. The majority of CLABSIs were due to oral or gastrointestinal organisms (83.0%). Skin organisms accounted for 8.5%. In a multivariable analysis, the strongest risk factors associated with CLABSI were diarrhea (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6–28.7), receipt of blood products in the preceding 4–7 days (OR 10.0, 95%CI 3.2–31.0), not receiving antibiotics (OR 8.3, 95%CI 2.8–25.0), and chemotherapy cycle (OR 3.5, 95%CI 1.4–8.9). CLABSIs led to increased morbidity, with 13 cases (32.5%) versus two controls (1.9%) requiring transfer to the pediatric intensive care unit (P < 0.001). Three (7.5%) of 40 CLABSI events resulted in or contributed to death.

Conclusions

Intensified line care efforts cannot eliminate all CLABSIs in the patients with AML. Exploring the role of mucosal barrier breakdown and/or the use of antibiotic prophylaxis may be effective strategies for further prevention of CLABSIs, supporting ongoing trials in this patient population.

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