Port-A-Catheter Infection Rate and Associated Risk Factors in Children Diagnosed with Acute Lymphoblastic Leukemia.
Notice bibliographique
Résumé
Abstract Abstract 987 Poster Board I-9 Background: Port-a-catheters are commonly used as vascular access device in children with Acute Lymphoblastic Leukemia (ALL) requiring long-term chemotherapy. Literature suggests that surgical procedures should not be performed in patients with very low neutrophil counts. Neutropenia, however, is very common in patients with ALL putting them at increased risk for infection and impaired wound healing. Objectives: 1) To determine if severe neutropenia, defined as neutrophil count < 500/mm3, on the day of port-a-catheter insertion is a risk factor for catheter-associated infection in children with ALL; 2) To evaluate the incidence of catheter-associated infection and wound dehiscence; 3) To assess other potential risk factors for infection, such as ALL risk category, dexamethasone use during induction therapy and nutritional status at the time of port-a-catheter insertion. Methods: This was a retrospective study conducted in children newly diagnosed with ALL (January 2005 to August 2008) who had a port-a-catheter inserted to assess catheter-associated infections and dehiscence. Demographic data, clinical characteristics, port-a-catheter insertion data and complications post-procedure were reviewed. The post-procedure complications were classified as early (≤ 30 days) or late (> 30 days). The end of catheter follow-up was March, 2009. The nutritional status was evaluated using albumin and total protein levels as well as the BMI-for-age z-score or weight-for-age z-score. Statistical analysis included descriptive and inferential statistics (Chi-squared test, Wilcoxon rank sum test and Kaplan-Meier survival curve). Results: 192 port-a-catheters were inserted in 179 patients with ALL in this 3.5 year time period. Most patients were started on chemotherapy 3 days prior to catheter insertion. A total of 43 catheter-associated infections (22.39%) were diagnosed and the infection rate was 0.35/1000 catheter-days. Children with severe neutropenia on the day of insertion (n=99) had a catheter-associated infection rate of 15.15%; whereas, non-severe neutropenic (≥ 500 cells/mm3) children (n=93) had a rate of 24.73%. This difference was not statistically significant (p=0.137). Out of 192 port-a-catheters, 12 (6.25%) had to be removed due to infection. The most common organisms to cause catheter removal were Coagulase Negative Staphylococcus and Staphylococcus aureus. Patients with high risk precursor B and T cell ALL had a statistically significant higher incidence of late catheter-associated infections (p=0.024) than standard risk ALL. Gender (p=0.863), use of dexamethasone during induction (p=0.201), low BMI-for-age z-score or weight-for-age z-score (p=0.659), low albumin (p=0.530), low total protein (p=0.759) and fever pre-procedure (p=0.339) were not risk factors for infection. Patients who had an early catheter-associated infection did not have a greater chance of having a late infection (p=0.813). Out of 9 wound dehiscences (4.68%), 5 presented also with a local infection. The catheter infection-free survival rate at 1 year was 88.6%, at 2 years was 86.7% and at 3 years was 83.9% (see Graph). Conclusion: This study shows that severe neutropenia on the day of port-a-catheter insertion does not increase the incidence of catheter-associated infection in children with ALL. In contrast, high risk ALL (precursor B and T cell) is a risk factor for late catheter-associated infections. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».