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van den Bosch CH, Loeffen YGT, van der Steeg AFW, van der Bruggen JT, Frakking FNJ, Fiocco M, van de Ven CP, Wijnen MHWA, van de Wetering MD. The CATERPILLAR study: an assessor-blinded randomized controlled trial comparing a taurolidine-citrate-heparin lock solution to a heparin-only lock solution for the prevention of central-line-associated bloodstream infections in paediatric oncology patients. J Hosp Infect 2024; 152:56-65. [PMID: 39004189 DOI: 10.1016/j.jhin.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Taurolidine-citrate(-heparin) lock solutions (TCHL) are suggested as a promising and safe method for the prevention of central-line-associated bloodstream infections (CLABSI). AIM To investigate the efficacy of TCHL for the prevention of CLABSI in paediatric oncology patients. METHODS An assessor-blinded randomized controlled trial at the Princess Máxima Centre for paediatric oncology, the Netherlands, was performed from 2020 to 2023. Paediatric oncology patients receiving a tunnelled central venous access device (CVAD) were eligible. A total of 462 patients were required to compare the TCHL to the heparin-only lock (HL). Patients were followed-up for the first 90 days after CVAD insertion. The primary outcome was the incidence of the first CLABSI from CVAD insertion until the end of follow-up. Intention-to-treat and per-protocol analyses were performed. FINDINGS In total, 232 were randomized in the HL and 231 in the TCHL group. A total of 47 CLABSIs were observed. The intention-to-treat analysis showed that a CLABSI was observed in 26 (11.2%) of the HL group patients versus 21 (9.1%) of the TCHL group patients; incidence rate ratio (IRR) of 0.81 (95% confidence interval (CI): 0.46-1.45) in favour of the TCHL group. The per-protocol analysis showed that a CLABSI was observed in 10 (7.9%) of the HL group patients versus 6 (4.8%) of the TCHL group patients; IRR of 0.59 (95% CI: 0.21-1.62) in favour of the TCHL group. Adverse events were more common in the TCHL group but rarely reported. CONCLUSION No difference was detected between the TCHL and HL in the incidence of CLABSI in paediatric oncology patients.
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Affiliation(s)
- C H van den Bosch
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands.
| | - Y G T Loeffen
- Department of Immunology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - J T van der Bruggen
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F N J Frakking
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Fiocco
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands; Medical Statistics, Mathematical Institute, Leiden, The Netherlands; Department of Biomedical Data Science Section Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - C P van de Ven
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - M H W A Wijnen
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
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Nunn JL, Takashima MD, Wray-Jones EM, Soosay Raj TA, Hanna DMT, Ullman AJ. Central venous access device adverse events in pediatric patients with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:662. [PMID: 39283363 PMCID: PMC11405478 DOI: 10.1007/s00520-024-08853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 09/02/2024] [Indexed: 09/20/2024]
Abstract
PURPOSE To systematically review the proportion and incidence of CVAD-associated complications in pediatric patients with cancer. METHODS PubMed, Embase, and the Cumulative Index of Nursing and Allied Health Literature were searched from 2012 to 2022. Cohort studies and the control arm of randomized controlled trials, which reported CVAD-associated complications in pediatric patients aged 0-18 years, were included. CVAD complications were defined as CVAD failure, central line-associated bloodstream infection (CLABSI), local infection, occlusion, CVAD-associated venous thromboembolism, dislodgement/migration, breakage/rupture, and dehiscence. The pooled proportion and incidence rate (IR) for each CVAD-associated complication were reported. RESULTS Of 40 included studies, there was mixed quality of methods and reporting. Approximately 31.4% (95% confidence interval [CI] 22.5-41.1; 6920 devices) of devices experienced a CVAD-associated complication, and 14.8% (95% CI 10.2-20.1; 24 studies; 11,762 devices) of CVADs failed before treatment completion (incidence rate (IR) of 0.5 per 1000 catheter days (95% CI 0.3-0.8; 12 studies; 798,000 catheter days)). Overall, 21.2% (95% CI 14.3-28.9; 26 studies; 5054 devices) of CVADs developed a CLABSI, with an IR of 0.9 per 1000 catheter days (95% CI 0.6-1.3; 12 studies; 798,094 catheter days). Tunneled central venous catheters (TCVC) and peripherally inserted central catheters (PICCs) were associated with increased complications in comparison to totally implanted venous access devices (TIVADs). CONCLUSION CVAD complication rates in this population remain high. TCVCs and PICCs are associated with increased complications relative to TIVADs. Insufficient evidence exists to guide device selection in this cohort, necessitating further research to determine the role of PICCs in pediatric cancer care. PROSPERO CRD42022359467. Date of registration: 22 September 2022.
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Affiliation(s)
- Jenna L Nunn
- Children's Health Queensland Hospital & Health Service, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
- Griffith University, Gold Coast, Australia.
| | - Mari D Takashima
- Children's Health Queensland Hospital & Health Service, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | | | - Trisha A Soosay Raj
- Children's Health Queensland Hospital & Health Service, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Diane M T Hanna
- The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- The Walter &, Eliza Hall Institute, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
| | - Amanda J Ullman
- Children's Health Queensland Hospital & Health Service, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
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Torres CJ, Rupp ME, Cawcutt KA. Intravascular Catheter-Related Bloodstream Infections: Contemporary Issues Related to a Persistent Problem. Infect Dis Clin North Am 2024:S0891-5520(24)00053-9. [PMID: 39261142 DOI: 10.1016/j.idc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Hospital-acquired infections, including central line associated bloodstream infections (CLABSI), are an ongoing source of cost, morbidity, and mortality worldwide. This article presents a summary of the impact of the recent SARS-CoV-2 pandemic on CLABSI incidence, an overview of current standard-of-care practices for reduction of CLABSI, and a look toward future changes in bacteremia metrics and challenges in prevention.
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Affiliation(s)
- Cristina J Torres
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA. https://twitter.com/unmc_ID
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Kelly A Cawcutt
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA. https://twitter.com/KellyCawcuttMD
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de Frutos Porras E, Cobo-Vázquez E, Hernanz Lobo A, Santos Sebastián MDM, Pérez Fernández E, Garrido Colino C, Cela E, Navarro Gómez ML. A Local Experience of Antibiotic Lock Therapy as an Adjunctive Treatment for Central Venous Catheter-Related Bloodstream Infections in Pediatric Oncology and Hematology Patients. CHILDREN (BASEL, SWITZERLAND) 2024; 11:983. [PMID: 39201919 PMCID: PMC11352447 DOI: 10.3390/children11080983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/18/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology-hematology ward. METHODS a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology-hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. RESULTS fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259-0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). CONCLUSIONS ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects.
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Affiliation(s)
- Elena de Frutos Porras
- Hospital Fundación de Alcorcón, C/Budapest 1, 28922 Madrid, Spain; (E.d.F.P.); (E.C.-V.); (E.P.F.)
| | - Elvira Cobo-Vázquez
- Hospital Fundación de Alcorcón, C/Budapest 1, 28922 Madrid, Spain; (E.d.F.P.); (E.C.-V.); (E.P.F.)
| | - Alicia Hernanz Lobo
- Hospital Maternoinfantil Gregorio Marañón, c/O’Donnell 46, 28009 Madrid, Spain; (A.H.L.); (M.d.M.S.S.); (C.G.C.); (E.C.)
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María del Mar Santos Sebastián
- Hospital Maternoinfantil Gregorio Marañón, c/O’Donnell 46, 28009 Madrid, Spain; (A.H.L.); (M.d.M.S.S.); (C.G.C.); (E.C.)
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Elia Pérez Fernández
- Hospital Fundación de Alcorcón, C/Budapest 1, 28922 Madrid, Spain; (E.d.F.P.); (E.C.-V.); (E.P.F.)
| | - Carmen Garrido Colino
- Hospital Maternoinfantil Gregorio Marañón, c/O’Donnell 46, 28009 Madrid, Spain; (A.H.L.); (M.d.M.S.S.); (C.G.C.); (E.C.)
| | - Elena Cela
- Hospital Maternoinfantil Gregorio Marañón, c/O’Donnell 46, 28009 Madrid, Spain; (A.H.L.); (M.d.M.S.S.); (C.G.C.); (E.C.)
| | - María Luisa Navarro Gómez
- Hospital Maternoinfantil Gregorio Marañón, c/O’Donnell 46, 28009 Madrid, Spain; (A.H.L.); (M.d.M.S.S.); (C.G.C.); (E.C.)
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Unidad de Investigación Maternoinfantil Fundación Familia Alonso, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, 28040 Madrid, Spain
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van den Bosch CH, Grant CN, Brown EG, Morrison ZD, Luques LM, Christison-Lagay ER, Baertschiger RM. Current surgical practice for central venous access to deliver chemotherapy and enteral access for nutritional support in pediatric patients with an oncological diagnosis. Pediatr Blood Cancer 2024:e31206. [PMID: 39030929 DOI: 10.1002/pbc.31206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
Central venous access through tunneled central venous catheters (CVCs) are one of the cornerstones of modern oncologic practice in pediatric patients since CVCs provide a reliable access route for the administration of chemotherapy. Establishing best practices for CVC management in children with cancer is essential to optimize care. This article reviews current best practices, including types of devices, their placement, complications, and long-term outcomes. Additionally, nutrition status and nutritional support are also very important determinants of outcomes and care in pediatric surgical oncology patients. We review current nutritional assessment, support, access for enteral and parenteral nutrition delivery, and their complications, mainly from a surgical perspective. Overall, access surgery, whether for CVCs, or for enteral access can be challenging, and best practice guidelines supported by current though limited evidence are necessary to minimize complications and optimize outcomes.
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Affiliation(s)
| | - Christa N Grant
- Division of Pediatric Surgery, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Erin G Brown
- Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, California, USA
| | - Zachary D Morrison
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lisandro M Luques
- Division of Pediatric Surgery, Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel
| | - Emily R Christison-Lagay
- Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reto M Baertschiger
- Division of Pediatric Surgery, Department of Surgery, DHMC, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA
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Garonzi C, Zeni F, Tridello G, Giacomazzi A, Castagna A, Esposto MP, Caddeo G, Pezzella V, Zaccaron A, Bonetti E, Vitale V, Chinello M, Balter R, Guardini B, Pedrazzoli E, Cesaro S. Results of a long-term, prospective study on complications of central venous catheter in pediatric patients with hematologic-oncologic diseases. Pediatr Blood Cancer 2024; 71:e30990. [PMID: 38605511 DOI: 10.1002/pbc.30990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Central venous catheter (CVC)-related complications remain a significant cause of morbidity in pediatric hematology-oncology. We prospectively surveyed the incidence of CVC-related complications in children with hematologic-oncologic diseases. PROCEDURE Five-hundred-eighty-one CVCs were inserted in 421 patients from January 2010 to June 2022 (153,731 CVC days observation; follow-up data up to December 31, 2022). RESULTS Overall, 671 complications were recorded (4.365/1000 CVC days): 49.7% malfunctions (1.88/1000 CVC days, 4.8% of CVC early removals), 23.9% bacteremia (0.90/1000, 15.1%), 19.6% mechanical complications (0.74/1000, 70.2%), 20.1% localized infections (0.76/1000, 17.1%), 0.5% thrombosis (0.02/1000, 33.3%). At multivariate analysis, risk factors for malfunction were Broviac-Hickman type of CVC (hazard ratio [HR] 2.5) or Port-a-cath (HR 3.4) or Proline (HR 4.3), p < .0001; for bacteremia double-lumen CVC (HR 3.2, p < .0001); for mechanical complications age at CVC insertion under median (HR 4.5, p < .0001) and Broviac-Hickman (HR 1.6) or Proline (HR 2.7), p = .01; finally for localized infections Broviac-Hickman (HR 2.9) or Proline (HR 4.4), p = .0001. The 2-year cumulative incidence of premature removal was 23.5%, and risk factors were age at CVC insertion under median (HR 2.4, p < .0001), Broviac-Hickman (HR 2.3) or Proline (HR 4.2), p < .0001. CONCLUSIONS Premature removal occurs in approximately 20%-25% of long-term CVCs. A surveillance program has a fundamental role in identifying the risk factors for CVC complications and the areas of intervention to improve CVC management.
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Affiliation(s)
- Chiara Garonzi
- Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Francesca Zeni
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alice Giacomazzi
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alberto Castagna
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Maria Pia Esposto
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giulia Caddeo
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Vincenza Pezzella
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Ada Zaccaron
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elisa Bonetti
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Virginia Vitale
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Matteo Chinello
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Rita Balter
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Beatrice Guardini
- Intensive Care and Anesthesia Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Eleonora Pedrazzoli
- Intensive Care and Anesthesia Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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van den Bosch C, Moree J, Peeters S, Lankheet M, van der Steeg A, Wijnen M, van de Wetering M, van der Bruggen J. The effect of taurolidine on the time-to-positivity of blood cultures. Infect Prev Pract 2024; 6:100352. [PMID: 38510847 PMCID: PMC10950745 DOI: 10.1016/j.infpip.2024.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
Background Taurolidine containing lock solutions (TL) are a promising method for the prevention of central line associated bloodstream infections. Per accident, the TL may not always be aspirated from the central venous catheter (CVC) before blood cultures are obtained. The TL could, unintentionally, end up in a blood culture vial, possibly altering the results. The aim of this study was to investigate the effect of the TLs on the detection of microbial growth in blood culture vials. Methods Different lock solutions (taurolidine-citrate-heparin (TCHL), taurolidine, heparin, citrate or NaCl) were added to BD BACTECTM blood culture vials (Plus Aerobic/F, Lytic/10 Anaerobic/F or Peds Plus/F) before spiking with Staphylococcus aureus (ATCC 29213 or a clinical strain) or Escherichia coli (ATCC 25922 or a clinical strain) in the presence and absence of blood. Subsequently, blood culture vials were incubated in the BD BACTEC FX instrument with Time-to-positivity (TTP) as primary outcome. In addition, the effect of the TCHL on a variety of other micro-organisms was tested. Discussion In the presence of taurolidine, the TTP was considerably delayed or vials even remained negative as compared to vials containing heparin, citrate or NaCl. This effect was dose-dependent. The delayed TTP was much less pronounced in the presence of blood, but still notable. Conclusion This study stresses the clinical importance of discarding TLs from the CVC before obtaining a blood culture.
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Affiliation(s)
- C.H. van den Bosch
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - J.E.P. Moree
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S. Peeters
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M. Lankheet
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A.F.W. van der Steeg
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - M.H.W.A. Wijnen
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - M.D. van de Wetering
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - J.T. van der Bruggen
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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van den Bosch CH, Frakking FNJ, Loeffen YGT, van Tinteren H, van der Steeg AFW, Wijnen MHWA, van de Wetering MD, van der Bruggen JT. The applicability of the central line-associated bloodstream infection (CLABSI) criteria for the evaluation of bacteremia episodes in pediatric oncology patients. Eur J Haematol 2024; 112:832-839. [PMID: 38294085 DOI: 10.1111/ejh.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The aim of this study was to investigate the applicability of the central line-associated bloodstream infection (CLABSI) criteria of the Centers for Disease Control and Prevention in pediatric oncology patients. METHODS Bacteremia episodes from 2020 to 2022 from a prospective cohort of pediatric oncology patients with a central venous catheter were included. Episodes were classified by three medical experts following the CLABSI criteria as either a CLABSI or non-CLABSI (i.e., contamination, other infection source, or mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI)). Subsequently, they were asked if and why they (dis)agreed with this diagnosis following the criteria. The primary outcome was the percentage of episodes where the experts clinically disagreed with the diagnosis given following the CLABSI criteria. RESULTS Overall, 84 bacteremia episodes in 71 patients were evaluated. Following the CLABSI criteria, 34 (40%) episodes were classified as CLABSIs and 50 (60%) as non-CLABSIs. In 11 (13%) cases the experts clinically disagreed with the diagnosis following the CLABSI criteria. The discrepancy between the CLABSI criteria and clinical diagnosis was significant; McNemar's test p < .01. Disagreement by the experts with the CLABSI criteria mostly occurred when the experts found an MBI-LCBI a more plausible cause of the bacteremia than a CLABSI due to the presence of a gram negative bacteremia (Pseudomonas aeruginosa n = 3) and/or mucositis. CONCLUSIONS A discrepancy between the CLABSI criteria and the evaluation of the experts was observed. Adding Pseudomonas aeruginosa as an MBI pathogen and incorporating the presence of mucositis in the MBI-LCBI criteria, might increase the applicability.
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Affiliation(s)
| | - Florine N J Frakking
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yvette G T Loeffen
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Harm van Tinteren
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Marc H W A Wijnen
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Jan-Tom van der Bruggen
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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9
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van den Bosch CH, Kops AL, Loeffen YGT, van der Steeg AFW, van de Wetering MD, Fiocco MF, Ekkelenkamp MB, Wolfs TFW. Central Venous Catheter-related Bloodstream Infections Caused by Enterobacterales in Pediatric Oncology Patients: Catheter Salvage or Removal. Pediatr Infect Dis J 2024; 43:49-55. [PMID: 37983368 PMCID: PMC10723766 DOI: 10.1097/inf.0000000000004106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The aim was to determine whether salvage treatment with systemic antibiotics is a safe and effective strategy for Enterobacterales bloodstream infections (BSI) in pediatric oncology patients with a central venous catheter (CVC). METHODS A retrospective study was performed on oncology and stem cell recipient patients with a CVC and blood culture with Enterobacterales , at the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands. Analyses were performed for all BSI and for episodes meeting central line-associated bloodstream infection (CLABSI) criteria. The cumulative incidence of an event (ie, removal, intensive care admission or death) was estimated after blood culture collection for episodes primarily treated with antibiotics. The effect of prognostic factors on the hazard of the event of interest was assessed by estimating a Cox proportional hazard regression model. RESULTS In total, 95 CVC-related Enterobacterales BSIs in 82 patients were included; 12 (13%) BSIs required immediate CVC removal and for 83 (87%) BSIs CVC salvage was attempted. The cumulative incidence of events at 60 days was 53.0% [95% confidence interval (CI): 41.7-63.1] for BSIs (n = 83), and 64.4% (95% CI: 48.3-76.7) for CLABSIs (n = 45). The events occurred after a median of 6 (Q1-Q3: 2-15) and 6 (Q1-Q3: 2-20) days for BSIs and CLABSIs, respectively. Intensive care admission after salvage treatment was required in 16% of the BSIs and CLABSIs, resulting in death in 5% and 2% of cases, respectively. No significant association between risk factors and events was found. CONCLUSIONS The cumulative incidence of an event at 60 days after salvage treatment for Enterobacterales CLABSIs and BSIs in pediatric oncology patients is high. Immediate CVC removal appears recommendable for this patient group.
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Affiliation(s)
| | - Aranka L. Kops
- From the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands
| | - Yvette G. T. Loeffen
- Department of Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | | | | | - Marta F. Fiocco
- From the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands
- Mathematical Institute, Leiden University, Leiden, the Netherlands
- Department of Biomedical Science, Section Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Miquel B. Ekkelenkamp
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Tom F. W. Wolfs
- Department of Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
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Neville JJ, Aye HM, Hall NJ. Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis. Arch Dis Child 2023; 108:975-981. [PMID: 37491140 DOI: 10.1136/archdischild-2023-325789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To evaluate and compare the complications associated with tunnelled external and implanted port (PORT) central venous catheters (CVCs) in children with cancer. DESIGN A systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was performed (pre-registered on PROSPERO: CRD42022300869). MEDLINE, Web of Science and the Cochrane Library databases were searched. PATIENTS Patients ≤18 years of age with haematological or solid malignancies. INTERVENTIONS Studies comparing tunnelled external and PORT CVCs. MAIN OUTCOMES MEASURES Infection, mechanical failure, thrombosis, bleeding, acceptability, quality of life (QoL), cost, premature removal, and days from insertion to removal for any reason. RESULTS Twenty-three observational studies met the inclusion criteria, representing 6644 devices and 6032 patients. Tunnelled external CVCs were associated with an increased risk for systemic infection (OR 2.10, 95% CI 1.59 to 2.77, p<0.001, 16 studies, 3425 devices). There was no significant difference in the risk of localised infection (OR 1.15, 95% CI 0.66 to 2.01, p=0.62, 5 studies, 979 devices). Tunnelled external CVCs were also associated with a significantly increased risk of mechanical complications (OR 2.47, 95% CI 1.21 to 5.05, p=0.01, 11 studies, 2187 devices) and premature device removal (OR 3.24, 95% CI 1.28 to 8.22, p=0.01, 6 studies, 1514 devices). CONCLUSION This study shows that PORTs associate with a reduced risk of infectious and mechanical complications, and a lower overall risk of removal, compared with tunnelled external CVCs in children with cancer. Further work is required to confirm these findings in a prospective randomised trial and to compare cost implications and acceptability to patients and caregivers.
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Affiliation(s)
- Jonathan J Neville
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hinn Moe Aye
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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11
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Sierra CM, Rodriquez C, Bahjri K. Ethanol Lock for Prevention of CVC-Related Bloodstream Infection in Pediatric Patients: A Systematic Review and Meta-Analysis. J Pediatr Pharmacol Ther 2023; 28:386-396. [PMID: 38130502 PMCID: PMC10731934 DOI: 10.5863/1551-6776-28.5.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/11/2022] [Indexed: 12/23/2023]
Abstract
Ethanol lock therapy (ELT) can be used in patients with an indwelling central line to assist in the prevention of central venous catheter (CVC)-associated infections. However, its efficacy has not been consistently demonstrated in the pediatric population. The primary objective of this review and meta-analysis was to determine the efficacy and safety of ELT in prevention of central line-associated bloodstream infection (CLABSI) in the pediatric population. A search was conducted with the PubMed, CINAHL, PSCYInfo, Cochrane Library, and Academic Search Premier databases from inception through January 21, 2022. Studies were included if they reported incidence of CVC-related infections with ELT in pediatric patients. Meta-analyses used random-effects models according to the heterogeneity of all included studies. Of 736 studies, 25 met inclusion criteria for review and 10 for inclusion in the meta-analysis. Meta-analysis with pre- and post-ELT treatment showed that use of ELT significantly decreased mean CVC-related infections when compared with pre-treatment with no ELT with a mean difference of -5.79 (95% CI, -9.08 to -2.51; p < 0.001). The number of CVC infections also significantly decreased (OR, 0.42; 95% CI, 0.23-0.75; p = 0.004). Increased risk of thrombosis and increased frequency of catheter breakage, repair, and replacement were noted in several studies. Ethanol lock therapy is effective in preventing infection related to central venous catheter use in pediatric patients. Further study is warranted to determine the optimal protocol for, and incidence of, adverse events related to use of ELT.
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Affiliation(s)
- Caroline M. Sierra
- Department of Pharmacy Practice (CMS), Loma Linda University School of Pharmacy, Loma Linda University, Loma Linda, CA
| | - Cristian Rodriquez
- Loma Linda University School of Pharmacy (CR), Loma Linda University, Loma Linda, CA
| | - Khaled Bahjri
- Department of Pharmaceutical and Administrative Sciences (KB), Loma Linda University School of Pharmacy, Loma Linda, CA
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van den Bosch CH, Loeffen Y, van der Steeg AFW, van der Bruggen JTT, Frakking FNJ, Fiocco M, van de Ven CP, Wijnen MHWA, van de Wetering MD. CATERPILLAR-study protocol: an assessor-blinded randomised controlled trial comparing taurolidine-citrate-heparin to heparin-only lock solutions for the prevention of central line-associated bloodstream infections in paediatric oncology patients. BMJ Open 2023; 13:e069760. [PMID: 36944461 PMCID: PMC10032404 DOI: 10.1136/bmjopen-2022-069760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The efficacy of taurolidine containing lock solutions for the prevention of central line-associated bloodstream infections (CLABSI) in paediatric oncology patients is still unknown. If the taurolidine-citrate-heparin lock appears to decrease the incidence of CLABSIs, we hope to increase the quality of life of children with cancer by subsequently reducing the central venous access device (CVAD)-removal rates, dispense of antibiotics, hospital admissions and incidence of severe sepsis resulting in intensive care unit admission. METHODS AND ANALYSIS This assessor-blinded randomised controlled trial including 462 patients was designed to compare the taurolidine-citrate-heparin lock to the heparin-only lock for the prevention of CLABSIs in paediatric oncology patients. Patients receiving their first CVAD at the Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands, are eligible for inclusion. The primary outcome of this study is the incidence of first CLABSIs from CVAD insertion until the end of the study, maximum follow-up of 90 days. An intention-to-treat and a per-protocol analysis will be performed. An interim analysis will be performed after the inclusion of 50% of the patients. The results of the interim analysis and overall conduct of the trial will be discussed by a data safety monitoring board. ETHICS AND DISSEMINATION The medical ethics committee NedMec, Utrecht, the Netherlands, has approved this research (number 20/370). Written informed consent for participation in this trial and publication of the trial data is obtained from all patients and/or their parents/guardians. The results of this trial will be published in a peer-reviewed journal and the data will be made available on reasonable request after publication of the main results manuscript. TRIAL REGISTRATION NUMBERS NTR6688; NCT05740150.
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Affiliation(s)
| | - Yvette Loeffen
- Department of Pediatric Infectious Diseases and Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | | | - Florine N J Frakking
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marta Fiocco
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Leiden University Mathematical Institute, Leiden, The Netherlands
| | | | - Marc H W A Wijnen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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13
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Central-line-associated bloodstream infections and central-line-associated non-CLABSI complications among pediatric oncology patients. Infect Control Hosp Epidemiol 2023; 44:377-383. [PMID: 35475427 PMCID: PMC10015264 DOI: 10.1017/ice.2022.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess central venous catheter (CVC) harm in pediatric oncology patients, we explored risks for central-line-associated bloodstream infections (CLABSIs) and central-line-associated non-CLABSI complications (CLANCs). DESIGN Retrospective cohort study. SETTING Midwestern US pediatric oncology program. PATIENTS The study cohort comprised 592 pediatric oncology patients seen between 2006 and 2016. METHODS CLABSIs were defined according to Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) definitions. CLANCs were classified using a novel definition requiring CVC removal. Patient-level and central-line-level risks were calculated using a negative binomial model to adjust for correlations between total events and line numbers. RESULTS CVCs were inserted in 62% of patients, with 175,937 total catheter days. The inpatient CLABSI and CLANC rates were 5.8 and 8.5 times higher than outpatient rates. At the patient level, shared risks included acute myeloid leukemia (AML) and age <1 year at diagnosis. At the line level, shared risks included age <1 year at diagnosis, non-mediports, and >1 lumen. AML was a CLABSI-specific risk. CLANC-specific risks included non-brain-tumor diagnosis, younger age at diagnosis or central-line placement, and age <1 year at diagnosis or line placement. Multivariable risks were for CLABSI >1 lumen and for CLANC age <1 year at placement. CONCLUSIONS Among patients with CVCs, CLABSI and CLANC rates were similar, higher among inpatients than outpatients. For both CLABSIs and CLANCs, infants and patients with AML were at higher risk. In both univariate and multivariate models, lines with >1 lumen were associated with CLABSIs and placement during infancy with CLANCs.
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Mansfield SA, Staszak J, Murphy AJ, Talbot L, Abdelhafeez A, Prajapati H, Gold R, Maller V, Proctor K, Davidoff AM, Williams RF. Impact of insertion site on complications in central venous access devices. Pediatr Surg Int 2023; 39:118. [PMID: 36773111 DOI: 10.1007/s00383-023-05399-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE There is still debate over the safest route for the placement of long-term central venous access devices. The aim of this study was to review a large, single-institution experience to determine the impact of access location on peri-operative complications. METHODS The records of patients undergoing subcutaneous port (SQP) and tunneled catheter insertion over a seven-year period were reviewed. Vein cannulated (subclavian (SCV) versus internal jugular (IJ) vein), and 30-day complications were assessed. Surgical complications included pneumothorax, hemothorax, infections, arrhythmia or malpositioning requiring intervention. RESULTS A total of 1,309 patients were included (618 SQP, 691 tunneled catheters). The location for insertion was SCV (909, 69.4%) and IJ (400, 30.6%). There were 69 complications (5.2%) (41, 4.5% SCV, 28, 7.0% IJV) including: malpositioning/malfunctioning (SCV 13, 1.4% and IJV 14, 3.0%), pneumothorax (SCV 4, 0.4% and IJV 1, 0.3%), hemothorax (SCV 0 and IJV 1, 0.3%), arrhythmia (SCV 1, 0.1%, and IJV 0), and infection within 30 days of placement (SCV 20, 2.2% and IJ 11, 2.8%). The complication rates were not significantly different based on site (p = 0.080). CONCLUSION There was no significant difference in complication rates when using the subclavian versus the internal jugular vein as the site for long-term central venous access. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Sara A Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Jessica Staszak
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Lindsay Talbot
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Abdelhafeez Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Hasmukh Prajapati
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Robert Gold
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Vinod Maller
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Kimberly Proctor
- Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Regan F Williams
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
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15
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Khera S, Kumar A, Parikh B, Simalti AK, Davera S, Mahajan P, Dhingra S. Safety and outcome of ultrasound-guided tunneled central venous catheter in children with cancers from low middle-income country: A prospective study. Pediatr Blood Cancer 2023; 70:e30029. [PMID: 36331108 DOI: 10.1002/pbc.30029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/27/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Central venous access devices (CVAD) are vital for cancer therapeutics in pediatric oncology. Tunneled vascular access devices (TVAD) are preferred in children for prolonged and frequent vascular access. Data on insertion, care, and complications of CVAD in children from low middle-income countries (LMIC) are scarce, heterogeneous, and retrospective. PROCEDURE This prospective observational study on eligible children <12 years with pediatric malignancies requiring chemotherapy for minimum 6 months from diagnosis excluded children with mucosal bleeding, coagulopathy, and infections. TVAD insertion was ultrasound (USG) guided. Number of catheter-days, surgical and nonsurgical complications, and risk factors for catheter-related bloodstream infections (CRBSI) were noted TVAD removal due to complications, therapy completion, tumor progression, or death. RESULTS Data from 61 of 86 eligible children with median age 42 months (range 1-144) were analyzed. Hematological malignancy and severe thrombocytopenia were seen in 37/61 (61%) and 18/61 (30%) children, respectively. First-attempt success rate was 74%. Surgical complications were seen in four of 61 (7%). Nonsurgical complications were seen in 33/61 (54%) children; CRBSI was commonest 24/61 (39%), causing removal of TVAD in 14/61 (23%). Incidence per 1000 catheter-days for CRBSI was 3.24. Antibiotic lock therapy could salvage nine of 24 TVAD with CRBSI. Thrombus and accidental removal was seen in six of 61 (10%) and four of 61 (7%). None of the studied risk factors were significantly associated with CRBSI. The mean insertion duration of TVAD was 121 ± 90 days. CONCLUSION USG-guided TVAD insertion is safe and reliable way for chemotherapy administration with acceptable complications in children with malignancies in LMIC, including children with severe thrombocytopenia.
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Affiliation(s)
- Sanjeev Khera
- Department of Pediatrics, Army Hospital Research and Referral, Delhi, India
| | - Amit Kumar
- Department of Pediatrics, Army Hospital Research and Referral, Delhi, India
| | - Badal Parikh
- Department of Anesthesia, Army Hospital Research and Referral, Delhi, India
| | - Aashish Kumar Simalti
- Department of Pediatrics, Military Hospital Dehradun, Army Hospital Research and Referral, Delhi, India
| | - Saket Davera
- Department of Pediatric Surgery, Army Hospital Research and Referral, Delhi, India
| | - Pooja Mahajan
- Department of Microbiology, Army Hospital Research and Referral, Delhi, India
| | - Sandeep Dhingra
- Department of Pediatrics, Army Hospital Research and Referral, Delhi, India
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16
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Rabelo BS, de Alvarenga KAF, Miranda JWFB, Fagundes TP, Cancela CSP, de Castro Romanelli RM, de Sá Rodrigues KE. Risk factors for catheter-related infection in children with cancer: A systematic review and meta-analysis. Am J Infect Control 2023; 51:99-106. [PMID: 35577057 DOI: 10.1016/j.ajic.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023]
Abstract
RATIONALE To understand the risk factors for catheter-related infection during treatment of pediatric cancer is essential to implement measures to prevent its occurrence. BACKGROUND We performed a comprehensive systematic review of the literature with meta-analysis to identify and synthesize the main risk factors for catheter-related infection in children undergoing oncological treatment. METHODS Systematic searches were conducted in Medline, Embase, Lilacs, and BVS (Biblioteca Virtual em Saúde) until January 2022, following PRISMA guidelines. The search was not limited to language or dates. Risk factors were divided into host-related, assistance-related, and catheter types. We also describe the most common pathogens. RESULTS Thirteen studies were included in the review. Diagnosis of hematological neoplasm, the intensity of treatment, blood transfusion in the 4-7 days before the infection, type of long-term catheters (tunneled externalized catheters, double lumen, greater diameter), inpatient treatment, and a longer period of hospitalization were the most consistent risk factors. Metanalysis showed that neutropenia at the moment of catheter placement is not a risk factor for central-line-associated bloodstream infections, however, there is high heterogeneity between studies. Staphylococcus epidermidis was the most common pathogen reported. CONCLUSIONS Understanding risk factors is an essential step to reduce morbidity and mortality of catheter-related infection. Education for preventive measures, reduction of hospitalization, wisely choosing the most adequate type of catheter, and the best moment for catheter insertion may reduce the occurrence of catheter-related infection.
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Affiliation(s)
- Bruna Salgado Rabelo
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil
| | | | | | | | - Camila Silva Peres Cancela
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Roberta Maia de Castro Romanelli
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Karla Emília de Sá Rodrigues
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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17
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Ding W, Qiu L, Li T, Su W, Yu Q, Hu T, Wang C, Fan C, Wang W. Ultrasound-guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut. Pediatr Blood Cancer 2022; 69:e29911. [PMID: 35880972 DOI: 10.1002/pbc.29911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the feasibility and safety of ultrasound-guided totally implantable venous access ports (TIVAPs) via the right brachiocephalic vein (BCV) in pediatric patients. METHODS A single-institute retrospective review was performed on 35 pediatric patients with predominantly hematological malignancies (88.6%) who underwent TIVAP implantation via ultrasound-guided right BCV approach from July 2018 to June 2021. The catheter tip was adjusted to be positioned at the cavoatrial junction under pulsed fluoroscopic guidance. Technical success rate, procedural information, and TIVAP-related complications were evaluated. RESULTS All the pediatric TIVAP devices were successfully implanted via right BCV access. Venous access was successful by first attempt in 32 children (91%), two cases (5.7%) required a second attempt, and one patient (2.9%) required a third attempt. The mean procedural time was 44.6 ± 6.4 minutes (range: 34-62 minutes). No intraoperative complications occurred. The average TIVAP indwelling time was 564 ± 208 days (range: 193-1014 days), with a cumulative 19,723 catheter-days. Overall, three patients (8.6%) experienced four postoperative complications (two cases of local hematoma and two catheter dysfunctions) at a rate of 0.2 per 1000 catheter-days. No other complications such as wound dehiscence, delayed incision healing, catheter-related thrombosis (CRT), catheter malposition/fracture, surgical site infection, catheter-related bloodstream infection (CRBSI), pinch-off syndrome, and drug extravasation were observed during follow-up. CONCLUSIONS Ultrasound-guided right BCV access for TIVAP placement in pediatric patients appears to be technically feasible, safe, and effective. Further large-sample, prospective studies are warranted.
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Affiliation(s)
- Wei Ding
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Lu Qiu
- Department of Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Tianyu Li
- Department of Hematology and Oncology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Weiwei Su
- Department of Cardiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Qian Yu
- Division of Interventional Radiology, Department of Radiology, Medical Center, University of Chicago, Chicago, Illinois, USA
| | - Tianshen Hu
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chunxin Wang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chen Fan
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Weidong Wang
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
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18
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Ross AB, Rouanet E, Murphy AJ, Weldon CB, Weil BR. Complications associated with totally implantable access ports in children less than 1 year of age. J Pediatr Surg 2022; 57:463-468. [PMID: 34991865 DOI: 10.1016/j.jpedsurg.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long term central venous access is necessary for the treatment of several conditions affecting young children. Totally implantable access ports (ports) offer the advantage of containing no external components, thus simplifying their care and maintenance. However, there is no consensus on the safety of port placement in infants (birth to 1-year of age). The aim of this study was to describe complications associated with port placement in infants, including which specific factors may be associated with risk for developing complications among these patients, and thereby assess the safety of port placement in this young population. METHODS A two-institution, retrospective cohort study identified patients under 1-year old who underwent port placement. Intraoperative, early postoperative (within 30 days), and late postoperative (greater than 30 days) complications were recorded. Multivariate logistic regression models were employed to assess factors associated with port-related complications. RESULTS Among 121 patients who received a port, 36 (30%) experienced a complication with a median time to complication of 299.5 days [IQR 67.5-440.75]. Of those, 26 required unplanned port removal. Only 3 patients (2.5%) experienced an intraoperative complication, and 3 patients (2.5%) experienced a complication within 30 days of port placement. A diagnosis of cancer was found to be protective against early catheter malfunction (OR=0.31, p = 0.03). A non-statistically significant trend associated with increased complications for large caliber devices (>6.0Fr) and weight <7-kg (OR 2.20, p = 0.06 and OR=2.26, p = 0.11 respectively) was observed. CONCLUSIONS Port placement appears to be safe for most infants with low or acceptable rates of intra- or post-operative complications. Smaller patient size (< 7 kg) and larger-sized catheters (> 6.0Fr) may be associated with an increased risk for complications among this population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Aaron B Ross
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, United States.
| | - Eva Rouanet
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA 02115, United States; Department of Surgery, Brigham & Women's Hospital/Harvard Medical School, Boston, MA 02115, United States
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA 02115, United States; Department of Pediatric Oncology, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA 02115, United States; Department of Anesthesiology, Critical Care & Pain Medicine, Children's Hospital/Harvard Medical School, Boston, MA 02115, United States
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA 02115, United States; Department of Pediatric Oncology, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA 02115, United States
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van den Bosch CH, Spijkerman J, Wijnen MHWA, Hovinga ICLK, Meyer-Wentrup FAG, van der Steeg AFW, van de Wetering MD, Fiocco M, Morsing IE, Beishuizen A. Central venous catheter-associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice. Support Care Cancer 2022; 30:8069-8079. [PMID: 35776186 PMCID: PMC9512752 DOI: 10.1007/s00520-022-07256-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/23/2022] [Indexed: 01/28/2023]
Abstract
Purpose The purpose of this study was to determine the most optimal central venous catheter (CVC) for pediatric patients with Hodgkin lymphoma (HL) in terms of complications. Methods A retrospective study including patients diagnosed with HL from 2015 to 2021 at the Princess Máxima Center was performed. Patients were followed from CVC insertion until removal or 06–2021, whichever came first. The primary outcome was the CVC-related complication incidence rate (IR) per 1000 CVC-days. Furthermore, the incidence rate ratio (IRR) was calculated by comparing complication IRs between peripherally inserted central catheters (PICC) and totally implantable venous access ports (TIVAP). Additionally, risk factors for central venous thrombosis (CVT) were identified. Results A total of 98 patients were included. The most frequently observed complications were local irritation/infections (18%; IR 0.93), malfunctions (15%; IR 0.88), and CVC-related CVTs (10%; IR 0.52). Single lumen PICCs were associated with a higher risk of complications (49% vs. 26%; IRR 5.12, CI95% 2.76–9.50), severe complications (19% vs. 7%; IRR 11.96, CI95% 2.68–53.42), and early removal (18% vs. 7%; IRR 9.96, CI95% 2.18–45.47). A single lumen PICC was identified as a risk factor for CVC-related CVT when compared to TIVAPs (12% vs. 7%, IRR 6.98, CI95% 1.45–33.57). Conclusion The insertion of a TIVAP rather than a PICC should be recommended for pediatric patients with HL, especially in the presence of CVT-related risk factors. Future trials should evaluate the efficacy and safety of direct oral anticoagulants for the primary prevention of CVT in pediatric patients with a PICC and other CVT-related risk factors. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07256-3.
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Affiliation(s)
| | - Judith Spijkerman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Idske C L Kremer Hovinga
- Van Creveldkliniek University Medical Centre Utrecht, Thrombosis and Hemostasis, Benign Hematology, Utrecht, The Netherlands
| | | | | | | | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Mathematical Institute, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Indra E Morsing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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20
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Rethinking Blood Testing in Pediatric Cancer Patients: A Quality Improvement Approach. Pediatr Qual Saf 2022; 7:e552. [PMID: 35720866 PMCID: PMC9197359 DOI: 10.1097/pq9.0000000000000552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: The overuse of blood tests burdens the healthcare system and can detrimentally impact patient care. Risks of frequent blood sampling include infection and clinician-induced anemia, which can negatively impact patients and their families. Pediatric cancer patients are particularly vulnerable as they are immunocompromised with a small blood volume. Four blood tests had become a daily practice. Therefore, we aimed to reduce the number of blood tests taken per bed day within the inpatient pediatric cancer unit by 15% within 8 months. Methods: This quality improvement project combined several strategies to reduce test frequency and empower clinicians on the rationale for blood test ordering. Recommendations were developed collaboratively presented in a summary table. Targeted behavior-change methodology built engagement and momentum for the change. All clinicians were challenged to STOP and THINK about why a test is necessary for each patient. The primary outcome measure was the frequency of the tests taken per bed day. Frequency was compared between pre- and postimplementation plus follow-up periods across 2019–2021. Results: 26,941 blood tests were captured in 1,558 admissions. The intervention led to an overall blood test reduction of 37% over 8 months. Liver Function Tests were the standout, with a 52% decrease in test frequency. Conclusions: A strategy incorporating education and culture change, combined with clear guidance on testing frequency, significantly reduced the ordering frequency of blood tests without increased patient harm.
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21
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Murray MJ, Moleron R, Adamski J, English M, Burke GAA, Cross J, Ajithkumar T, Stoneham S, Nicholson JC. Vinblastine monotherapy induction prior to radiotherapy for patients with intracranial germinoma during the COVID-19 pandemic. Pediatr Blood Cancer 2022; 69:e29359. [PMID: 34520101 PMCID: PMC8662027 DOI: 10.1002/pbc.29359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with localized intracranial germinoma have excellent survival. Reducing treatment burden and long-term sequelae is a priority. Intensive inpatient chemotherapy (e.g., carboPEI = carboplatin/etoposide/ifosfamide) has been effectively employed to reduce radiotherapy treatment volume/dose. Outpatient-based carboplatin monotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology), and successful vinblastine monotherapy induction (with 77% tumor volume reduction after just two weekly vinblastine doses) has recently been reported in an intracranial germinoma patient. METHODS Adapted UK guidelines for germ cell tumor management were distributed during the COVID-19 pandemic, including nonstandard treatment options to reduce hospital visits and/or admissions. This included vinblastine monotherapy for intracranial germinoma (6 mg/m2 intravenously, or 4 mg/m2 for moderate count suppression, delivered weekly). We describe two such patients treated using this approach. RESULTS A 30-year-old male with a localized pineal tumor received 12-week vinblastine induction, with >60% volume reduction, prior to definitive radiotherapy. A 12-year-old female with a metastatic suprasellar tumor and progression at all sites of disease whilst awaiting proton radiotherapy received two vinblastine doses with good early response, including 36% primary tumor volume reduction. The patients tolerated vinblastine well. CONCLUSION Patients with intracranial germinoma have excellent outcomes, and reduction of late effects remains a priority. The description of vinblastine monotherapy in these intracranial germinoma patients warrants further exploration.
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Affiliation(s)
- Matthew J. Murray
- Department of PathologyUniversity of CambridgeCambridgeUK,Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Rafael Moleron
- Department of Clinical OncologyAberdeen Royal InfirmaryAberdeenUK
| | - Jennifer Adamski
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - Martin English
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - G. A. Amos Burke
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Justin Cross
- Department of RadiologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Thankamma Ajithkumar
- Department of OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sara Stoneham
- Department of Paediatric and TYA OncologyUniversity College Hospital LondonLondonUK
| | - James C. Nicholson
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
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22
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van den Bosch CH, Jeremiasse B, van der Bruggen JT, Frakking FNJ, Loeffen YGT, van de Ven CP, van der Steeg AFW, Fiocco MF, van de Wetering MD, Wijnen MHWA. The efficacy of taurolidine containing lock solutions for the prevention of central-venous-catheter-related bloodstream infections: a systematic review and meta-analysis. J Hosp Infect 2021; 123:143-155. [PMID: 34767871 DOI: 10.1016/j.jhin.2021.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/16/2021] [Accepted: 10/30/2021] [Indexed: 12/25/2022]
Abstract
The incidence of central venous catheter (CVC)-related bloodstream infections is high in patients requiring a long-term CVC. Therefore, infection prevention is of the utmost importance. The aim of this study was to provide an updated overview of randomized controlled trials (RCTs) comparing the efficacy of taurolidine containing lock solutions (TL) to other lock solutions for the prevention of CVC-related bloodstream infections in all patient populations. On 15th February 2021, PubMed, Embase and The Cochrane Library were searched for RCTs comparing the efficacy of TLs for the prevention of CVC-related bloodstream infections with other lock solutions. Exclusion criteria were non-RCTs, studies describing <10 patients and studies using TLs as treatment. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A random effects model was used to pool individual study incidence rate ratios (IRRs). Subgroup analyses were performed based on the following factors: CVC indication, comparator lock and bacterial isolates cultured. A total of 14 articles were included in the qualitative synthesis describing 1219 haemodialysis, total parenteral nutrition and oncology patients. The pooled IRR estimated for all patient groups together (nine studies; 918 patients) was 0.30 (95% confidence interval 0.19-0.46), favouring the TLs. Adverse events (10 studies; 867 patients) were mild and scarce. The quality of the evidence was limited due to a high risk of bias and indirectness of evidence. The use of TLs might be promising for the prevention of CVC-related bloodstream infections. Large-scale RCTs are needed to draw firm conclusions on the efficacy of TLs.
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Affiliation(s)
- C H van den Bosch
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - B Jeremiasse
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - J T van der Bruggen
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F N J Frakking
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Y G T Loeffen
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - C P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - M F Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Mathematical Institute, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | | | - M H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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23
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Kalaycı E, Çalışkan Z. The Quality of Life and Influencing Factors in Turkish Children Receiving Cancer Treatment. J Pediatr Nurs 2021; 61:213-218. [PMID: 34126331 DOI: 10.1016/j.pedn.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study was conducted to determine the quality of life and the influencing factors in children aged 8-12 years who are treated for cancer in Turkey. DESIGN AND METHODS The cross-sectional and descriptive study was conducted on 300 children with cancer and their parents. The data were collected using the Questionnaire Form and the Pediatric Quality of Life Inventory PedsQL (4.0) Child and Parent Form. Descriptive statistics, the independent t-test, univariate and multiple binary logistic regression analysis were used for the evaluation. RESULTS The mean age of the children was 8.92 ± 0.98 years and the quality of life scores in all sub-dimensions and in total (36.26 ± 5.23) were found to be low. According to the univariate binary logistic regression analysis, the father being unemployed, the house being heated with a stove, and development of extravasation during the chemotherapy treatment process created a risk of decreasing the children's quality of life score (7.15 units, 41.29 units, and 44.47 units, respectively) (p < 0.05). CONCLUSIONS The father's unemployment, heating the house with a stove, and the development of extravasation during treatment were found to affect the children's quality of life negatively in the study. Inter-institutional cooperation, taking the necessary measures to decrease the frequency of extravasation development, and ensuring nurses continue family-centered care during these processes are recommended to support the families. PRACTICE IMPLICATIONS Interventions for early detection and prevention of the negative changes related to the quality of life in children with cancer need to be planned.
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Affiliation(s)
- Eda Kalaycı
- Erciyes University, Children Oncology-Hematology Clinic, Turkey
| | - Zehra Çalışkan
- Department of Pediatric Nursing, Semra and Vefa Küçük Faculty of Health Sciences, Nevşehir Hacı Bektaş Veli University, Turkey.
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24
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Low Risk of Central Line-associated Bloodstream Infections in Pediatric Hematology/Oncology Patients. Pediatr Infect Dis J 2021; 40:827-831. [PMID: 33990520 DOI: 10.1097/inf.0000000000003177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Central venous lines (CVLs) are essential for standard care of pediatric hematology/oncology patients providing safe administration of cytotoxic drugs and pain-free blood sampling. Central line-associated bloodstream infections (CLABSIs) cause significant morbidity. This study describes the epidemiology, microbiology, and risk factors for CLABSI in all children with malignancies in Iceland. METHODS All children that were diagnosed with malignancy in Iceland and received a CVL during 2008-2017 were included in the study. Characteristics of CVLs and patients were registered, information on risk factors, and microbiology was collected. International standards were used for CLABSI definition. RESULTS One hundred forty-three CVLs were placed in 94 children. Acute lymphoblastic leukemia was the most common underlying disease (31/94). Median age was 7 years. Implantable ports were the most commonly placed CVLs (82/143, 57%), tunneled lines were 39 (27%). Overall CLABSI rate was 0.24 infections/1000 line-days (14 episodes in 58,830 line-days), with little fluctuations. No CLABSI episodes occurred for 4 consecutive years (2012-2015). Staphylococci (of which 7 Staphylococcus aureus) were the cause of 10/14 episodes. Nine CLABSI episodes led to line removal, but no deaths were linked to CLABSIs. CONCLUSION We report very low CLABSI rates over a 9-year period at our hospital, with 4 consecutive CLABSI-free years. Even with the addition of episodes of possible CLABSI, rates were still very low and lower than most published reports.
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25
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Ordóñez J, Del Cañizo A, Beléndez C, García-Morín M, Pérez-Egido L, Fanjul M, García-Casillas MA, Cerdá J, Peláez D, Bardón E, de Agustín JC, Cela E. Complications of Central Venous Access Devices in Patients With Sickle Cell Disease and Thalassemia Major. J Pediatr Hematol Oncol 2021; 43:e655-e660. [PMID: 33093353 DOI: 10.1097/mph.0000000000001972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/15/2020] [Indexed: 01/19/2023]
Abstract
Pediatric patients with sickle cell disease and thalassemia major present clinical characteristics that could lead to a higher incidence of central venous access devices-associated complications (CVAD-C). With the objective of analyzing the safety of the use of CVAD in these patients, a retrospective review including all pediatric patients with these pathologies who required the implantation of a CVAD between 2004 and 2019 was performed. In all, 54 patients with 100 CVAD (65 totally implantable venous access port with subcutaneous reservoir, 35 single-lumen or double-lumen partially tunneled catheter) were included. During 60,410 days at risk of suffering a CVAD-C, 55 complications (complication rate [CR]/1000 catheter-days at risk=0.91) were reported in 46 CVAD: 19 mechanicals (CR=0.32), 32 infectious (CR=0.53), and 4 thrombotic complications (CR=0.066). Incidence of mechanical and infectious complications was significantly higher in double-lumen partially tunneled catheter than in totally implantable venous access port with subcutaneous reservoir (P<0.001). Lower age at insertion was related with a higher incidence of any complication (odds ratio=0.88/y, P=0.02). Patients who required a stem cell transplantation (31 patients and 65 CVAD) had no significant higher incidences of CVAD-C. In conclusion, our study supports the safety of using CVAD in these patients, with a low incidence of infectious, thrombotic, and mechanical complications.
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Affiliation(s)
| | | | - Cristina Beléndez
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | - Marina García-Morín
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | | | | | | | - Eduardo Bardón
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Elena Cela
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
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26
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Blom T, Lurvink R, Aleven L, Mensink M, Wolfs T, Dierselhuis M, van Eijkelenburg N, Kraal K, van Noesel M, van Grotel M, Tytgat G. Treatment-Related Toxicities During Anti-GD2 Immunotherapy in High-Risk Neuroblastoma Patients. Front Oncol 2021; 10:601076. [PMID: 33680926 PMCID: PMC7925836 DOI: 10.3389/fonc.2020.601076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
The introduction of immunotherapy using an anti-GD2 antibody (dinutuximab, ch14.18) has significantly improved survival rates for high-risk neuroblastoma patients. However, this improvement in survival is accompanied by a substantial immunotherapy-related toxicity burden. The primary objective of this study was to describe treatment-related toxicities during immunotherapy with dinutuximab, IL-2, GM-CSF, and isotretinoin. A retrospective, single center analysis of immunotherapy-related toxicities was performed in twenty-six consecutive high-risk neuroblastoma patients who received immunotherapy as maintenance therapy in the Princess Máxima Center (Utrecht, Netherlands). Toxicities were recorded and graded according to the CTCAE. Particular attention was drawn to pain and fever management and toxicities leading to dose modifications of dinutuximab and IL-2. Twenty-three patients (88%) completed all six courses of immunotherapy. Disease progression, isotretinoin-associated liver toxicity, and catheter-related infection in combination with peripheral neuropathy were reasons for immunotherapy discontinuation. The most common grade ≥3 toxicities for courses 1-5, respectively, were pain, catheter-related infections, and fever. In total, 310 grade ≥3 toxicities were recorded in 124 courses. Thirty-three grade 4 toxicities in 19/26 patients and no grade 5 toxicities (death) were seen. Fifty-nine percent of grade ≥3 toxicities were recorded in the two courses with IL-2. Catheter-related bloodstream infections were identified in 81% of patients. Four of these episodes led to intensive care admission followed by full recovery (grade 4).
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Affiliation(s)
- Thomas Blom
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Leonie Aleven
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Maarten Mensink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Tom Wolfs
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Kathelijne Kraal
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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27
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Bough G, Lambert NJ, Djendov F, Jackson C. Unexpected tunnelled central venous access demise: a single institutional study from the UK. Pediatr Surg Int 2021; 37:109-117. [PMID: 33159555 DOI: 10.1007/s00383-020-04771-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the factors involved in the demise of tunnelled central vascular access devices (CVADs) in children and describe patterns of failure. METHODS A retrospective study including children under 16 years of age undergoing CVAD insertion in a tertiary centre between October 2014 and December 2019. The Kaplan-Meier estimator was used to study CVAD survival and piecewise exponential curves to approximate hazard rates. Related factors were analysed using multivariable regression. RESULTS Totally, 684 CVADs were inserted in 499 children. Devices were in situ for 213,821 days (median 244.5). Of those, 261 CVADs (38.2%) failed prematurely; 176 (67%) required replacement. Tunnelled external lines (TELs) failed more frequently than totally implantable devices (p < 0.005).TEL displacement occurred in two high-risk phases, falling to baseline after 90 days. Low age at device insertion and open placement were strongly associated with an increased failure rate. Previous CVAD failure did not increase subsequent failure rate. Premature failure increased procedural cost by £153,949 per year. CONCLUSIONS TIDs should be placed in preference to TELs where appropriate. TELs are at highest risk of displacement for 90 days and must be well secured for this duration. Meticulous line care offers significant potential cost savings by reducing line replacements. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Georgina Bough
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nicholas J Lambert
- Department of Physics, University of Otago, Dunedin, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
| | - Florin Djendov
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Claire Jackson
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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28
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Hayes KB, Sheller B, Williams BJ, Churchill SS. Inpatient dental consultations at a pediatric hospital: A single center 1-year review. SPECIAL CARE IN DENTISTRY 2020; 41:60-65. [PMID: 33080093 DOI: 10.1111/scd.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
AIMS Inpatient dental consultations done at a pediatric hospital in 2017 were analyzed to determine consult reasons, requesting departments, and patient characteristics. Findings were compared to a 2007 study from the hospital. METHODS AND RESULTS Data were collected from medical records. Descriptive statistics and logistic regressions were calculated. In 2017, 300 consults were performed for 211 patients (1.8% of inpatients). hematology-oncology requested the most consults (63%). Evaluation prior to cancer treatment, cardiac surgery, or organ transplantation was the most common reason for consult requests (52%). Fifty-eight percent patients had a dental home; older patients were more likely to have a dental home (P < .001). Patients with a dental home were less likely to have caries (P = .047). Many patients with a dental home had caries (33% in 2007 and 29% in 2017); more patients without a dental home had caries (46% in 2007 and 38% in 2017). CONCLUSIONS This study both supports the dental home concept and reveals that many children with a dental home have treatment needs. This indicates that medical providers should not equate having a dental home with having dental health and emphasizes the value of an in-hospital dental service to support the management of critically ill children.
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Affiliation(s)
- Kyler B Hayes
- Department of Orthodontics and Pediatric Dentistry, University of Washington School of Dentistry, Seattle, Washington
| | - Barbara Sheller
- Department of Orthodontics and Pediatric Dentistry, University of Washington School of Dentistry, Seattle, Washington.,Pediatric Dentistry, Seattle Children's Hospital, Seattle, Washington
| | - Bryan J Williams
- Department of Orthodontics and Pediatric Dentistry, University of Washington School of Dentistry, Seattle, Washington.,Pediatric Dentistry, Seattle Children's Hospital, Seattle, Washington
| | - Shervin S Churchill
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
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29
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Saltzman AF, Carrasco A, Hecht S, Walker J, Caldwell BT, Bruny JL, Cost NG. A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors. J Pediatr Surg 2020; 55:1334-1338. [PMID: 31128844 DOI: 10.1016/j.jpedsurg.2019.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE While many children with renal tumors require long term venous access (VA) for adjuvant chemotherapy, certainly not all do. This study develops and tests a VA decision tree (DT) to direct the placement of VA in patients with renal tumors. METHODS Utilizing data readily available at surgery a VADT was developed. The VADT was tested retrospectively by 2 independent reviewers on a historic cohort. The ability of the VADT to appropriately select which patients would benefit from VA placement was tested. RESULTS 160 patients underwent renal tumor surgery between 2005 and 2018. 70 (43.8%) patients met study criteria with median age of 45.1 months (range 1.1-224); 73% required VA. Using the VADT, VA placement was "needed" in 67.1% of patients and "deferred" in 32.9%. Interrater reliability was very high (kappa = 0.97, 95% CI 0.91-1, p < 0.001). The sensitivity and specificity of the VADT to correctly decide on VA placement were 0.92 (0.8-0.98) and 1 (0.79-1). Using the VADT, no patient would have undergone unnecessary VA placement. In reality, 4.3% of patients had an unnecessary VA placed which required a subsequent removal. CONCLUSIONS These preliminary data support the continued study of this VADT to guide intraoperative decisions regarding VA placement in patients with renal tumors. LEVEL OF EVIDENCE III - Study of diagnostic test.
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Affiliation(s)
- Amanda F Saltzman
- Department of Urology, University of Kentucky, Lexington, KY; Department of Surgery, Division of Urology, University of Colorado and Children's Hospital Colorado, Aurora, CO
| | - Alonso Carrasco
- Department of Surgery, Division of Urology, University of Colorado and Children's Hospital Colorado, Aurora, CO; Department of Pediatric Urology, Kansas Mercy Children's Hospital, Kansas City, MO
| | - Sarah Hecht
- Department of Surgery, Division of Urology, University of Colorado and Children's Hospital Colorado, Aurora, CO
| | - Jonathan Walker
- Department of Surgery, Division of Urology, University of Colorado and Children's Hospital Colorado, Aurora, CO
| | - Brian T Caldwell
- Department of Surgery, Division of Urology, University of Colorado and Children's Hospital Colorado, Aurora, CO
| | - Jennifer L Bruny
- Department of Surgery, Division of Pediatric Surgery, University of Colorado and Children's Hospital Colorado, Aurora, CO
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado and Children's Hospital Colorado, Aurora, CO.
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30
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Martynov I, Klima-Frysch J, Kluwe W, Engel C, Schoenberger J. Safety of tunneled central venous catheters in pediatric hematopoietic stem cell recipients with severe primary immunodeficiency diseases. PLoS One 2020; 15:e0233016. [PMID: 32413055 PMCID: PMC7228048 DOI: 10.1371/journal.pone.0233016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Tunneled central venous catheters (TCVCs) provide prolonged intravenous access for pediatric patients with severe primary immunodeficiency disease (PID) undergoing hematopoietic stem cell transplantation (HSCT). However, little is known about the epidemiology and clinical significance of TCVC-related morbidity in this particular patient group. We conducted the retrospective analysis of patients with severe PID who received percutaneous landmark-guided TCVC implantation prior to HSCT. We analyzed 92 consecutive TCVC implantations in 69 patients (median [interquartile range] age 3.0 [0-11] years) with severe combined immune deficiency (n = 39, 42.4%), chronic granulomatous disease (n = 17, 18.4%), and other rare PID syndromes (n = 36, 39.2%). The median length of TCVC observation was 144.1 (85.5-194.6) days with a total of 14,040 catheter days at risk (cdr). The overall rate of adverse events during catheter insertion was 17.4% (n = 16) and 25.0% during catheter dwell period (n = 23, catheter risk [CR] per 1000 cdr = 1.64). The most common complication was TCVC-related infection with an overall prevalence of 9.8% (n = 9, CR = 0.64), followed by late dislocation (n = 6, 6.5%, CR = 0.43), early dislocation (n = 4, 4.3%) and catheter dysfunction (n = 4, 4.3%, CR = 0.28). TCVCs are safe in children with severe PID undergoing HSCT with relatively low rates of TCVC-related infection.
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Affiliation(s)
- Illya Martynov
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Jessica Klima-Frysch
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Wolfram Kluwe
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Joachim Schoenberger
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
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