title: Severe neutropenia at time of port insertion is not a risk factor for catheter-associated infections in children with acute lymphoblastic leukemia.
abstract: BACKGROUND
  The objective of this study was to determine whether severe neutropenia on the day of port-a-catheter (PORT) insertion was a risk factor for catheter-associated infection (CAI) in children with acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  This was a retrospective study of children with ALL who had a PORT insertion between January 2005 and August 2008. Early (≤ 30 days) and late (>30 days) postprocedure complications were reviewed. The length of follow-up ranged between 7 months and 42 months.
  
  
  RESULTS
  In total, 192 PORTs were inserted in 179 children. There were 43 CAIs (22%), and the infection rate was 0.35 per 1000 catheter-days. The CAI rate (15%) in children who had severe neutropenia on the day of the procedure did not differ statistically from the CAI rate (24%) in children who did not have severe neutropenia (P = .137). Conversely, patients with severe neutropenia who had a CAI were more likely to have their PORT removed (P = .019). The most common organisms to cause catheter removal were coagulase-negative Staphylococcus and Staphylococcus aureus. Patients with high-risk ALL had a statistically significant higher incidence of late CAI than patients with standard-risk ALL (P = .012). Age (P = .272), positive blood culture preprocedure (P = 1.0), and dexamethasone use (P = .201) were not risk factors for CAI. Patients who had an early CAI did not have a greater chance of having a late CAI. The catheter infection-free survival rate at 1 year was 88.6%.
  
  
  CONCLUSIONS
  The current results indicated that severe neutropenia on the day of PORT insertion does not increase the risk of CAI in children with ALL.
authors.affiliation: Department of Diagnostic Imaging-Image Guided Therapy Center, The Hospital for Sick Children, Toronto, Ontario, Canada. beatriz.lp.junqueira@gmail.com
authors.forename: Beatriz L P
authors.initials: BL
authors.lastname: Junqueira
authors.forename: Bairbre
authors.initials: B
authors.lastname: Connolly
authors.forename: Oussama
authors.initials: O
authors.lastname: Abla
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Joao G
authors.initials: JG
authors.lastname: Amaral
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000150:complications*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012307:Risk Factors