Postoperative neutropaenia tied to early CRBSI in children with leukaemia

Paediatric patients with acute myeloid leukaemia and other leukaemias (AML/OLs), especially those with persistent neutropaenia during the first 30 postoperative days, are at increased risk of early catheter-related bloodstream infections (CRBSIs), according to a Singapore study.

“Contrary to common belief, low preoperative absolute neutrophil counts and lack of preoperative antibiotics were not associated with higher early CRBSI rates,” said the researchers, led by Wen Qi Cher from the Department of Pediatric Medicine, KK Women’s and Children’s Hospital, Singapore.

Cher and colleagues retrospectively reviewed national registry records of newly diagnosed paediatric cancer patients with port-a-caths inserted using standardized perioperative protocols in which only antibiotic use was not regulated. They assessed the association of preoperative factors and postoperative blood count with 30-day postoperative CRBSI incidence using logistic regression and linear trend analysis, respectively.

During a median of 14 postoperative days, 17 CRBSIs (7.0 percent) occurred among 243 patients. Early CRBSIs showed a significant correlation with cancer type (AML/OLs vs solid tumours and lymphomas [STLs]: odds ratio [OR], 5.09; p=0.0036; acute lymphoblastic leukaemia vs STL: OR, 0.83; p=0.0446). [Pediatr Infec Dis J 2022;41:133-139]

In contrast, preoperative antibiotics, absolute neutrophil counts, and white blood cell counts were not significantly associated with higher early CRBSI rates.

Significant differences were also noted in 30-day postoperative absolute neutrophil counts and white blood cell trends between patients with acute lymphoblastic leukaemia and STLs (OR, 0.83; p<0.05), as well as between AML/OLs and STLs (OR, 5.09; p<0.005). Of note, patients with AML/OL had the most protracted neutropaenia during this period.

“Our findings do not support the use of empirical preoperative antibiotics and instead identify prolonged postoperative neutropaenia as a major contributing factor for early CRBSI,” the researchers said.

Moreover, the results of this study echo those of a 2014 study, which found no benefit of adjunctive antibiotic lock therapy (ALT) in patients with CRBSI. [Pediatr Blood Cancer 2014;61:1811-1815]

Lead author Joshua Wolf from the Department of Infectious Diseases, St Jude Children's Research Hospital, US, and his team conducted a retrospective matched cohort study of ALT use for the treatment of CRBSI in paediatric haematology/oncology patients at their institution between 2006 and 2012.

Wolf and colleagues identified 38 eligible episodes of CRBSI treated with adjunctive ALT and compared these to 73 episodes treated with standard therapy alone, matched by catheter-type and organism.

Treatment failure did not significantly differ between ALT and standard therapy groups (50.0 percent vs 38.4 percent; p=0.24), but the timing did. In the ALT cohort, immediate removal of central venous catheters was less common (0.0 percent vs 12.3 percent; p=0.03), while delayed removal (4‒13 days) and infection relapse were more common (50.0 percent vs 24.7 percent; p=0.01).

“This retrospective study was unable to identify any benefit of adjunctive ALT in paediatric oncology patients with CRBSI,” the authors said. “The available evidence does not support routine ALT use.”