Central venous catheters are essential to treatment of cancer in children. There are no studies comparing adult to pediatric as far as CLABSI or catheter-related bloodstream infections (CRBSI) in cancer patients, given the challenges in applying adult definitions and management to children. In this study, we described the epidemiology and management of CLABSI in a pediatric population of cancer patients and compared it to an adult population from the same institution.
We retrospectively reviewed the electronic medical records of 92 pediatric and 156 adult patients with CLABSI/CRBSI cared for at MD Anderson Cancer Center between September 2005 and March 2014. The protocol was approved by the institutional review board and a waiver of informed consent was obtained.
A total of 92 pediatric patients with a median age of 6 years (range 5 months-17years) were compared with 156 adult patients with a median age of 55 years (range 19-87 years). There was a significant difference in etiology of CLABSI between pediatric and adult patients (p=0.002), with the latter having more gram negative organisms isolated (27% in pediatric vs 46% in adults). Polymicrobial organisms were seen more commonly in pediatric (10% vs 1%, p=0.003). Overall adult patients were more likely to have a hematologic malignancy (74% vs 58%, p=0.013), have had a stem cell transplant in the preceding year (25% vs 13%, p=0.024) and have neutropenia at presentation (54% vs 40%, p=0.038). However neutropenia was not statistically associated with higher rates of gram negative organisms in pediatric or adult patients (p=0.65 and p=0.69 respectively), neither were hematologic malignancies (p=0.76 for pediatric patients and p=0.51 for adult patients). Peripheral blood cultures were available in only 43% of pediatric cases. CVC was removed in 64% of pediatric cases versus 88% of adult cases (p< 0.0001).
We found higher rates of gram negative organisms in adults and higher rates of polymicrobial in children. Because of the low rates of peripheral blood cultures and the low rates of CVC removal, CRBSI diagnosis could be challenging in pediatrics. A modified CRBSI definition relying on clinical criteria may be warranted.
R. Hachem, None
Y. Jiang, None
M. Michael, None
A. M. Chaftari, None
I. Raad, UT MD Anderson Cancer Center: Shareholder , Licensing agreement or royalty
Novel Anti-Infective Technologies LLC: Shareholder , Licensing agreement or royalty