Factors influencing central line infections in children with acute lymphoblastic leukemia: results of a single institutional study
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Published on: October 17, 2025
Adil A H Abbas1, Christopher J H Fryer, Charles Paltiel
1Division of Pediatric Oncology, Princess Nourah Oncology Centre, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia.
Insights
Central lines in children with acute lymphoblastic leukemia (ALL) have high infection rates. Young age and treatment protocol are key risk factors for infection, not catheter type or insertion timing.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Medical Devices
Background:
- Central venous catheters are crucial for treating acute lymphoblastic leukemia (ALL) in children.
- Comparing infection rates between external catheters (ECs) and totally implantable devices (TIDs) is important for patient safety.
- The timing of catheter insertion may influence infection risk in pediatric ALL patients.
Purpose of the Study:
- To compare infection rates between external catheters (ECs) and totally implantable devices (TIDs) in children with acute lymphoblastic leukemia (ALL).
- To evaluate the impact of catheter insertion timing on infection risk in this patient population.
Main Methods:
- Retrospective and prospective data collection on central line use in children with ALL.
- Analysis of infection episodes per 1,000 catheter days for ECs and TIDs.
- Identification of risk factors for infection, including age, treatment protocol, and insertion timing.
Main Results:
- A high overall infection rate of 3.43 episodes per 1,000 catheter days was observed.
- Infections were a primary cause of complications, accounting for 51% of line-related issues.
- Younger age and specific treatment protocols were identified as significant risk factors for initial infections.
Conclusions:
- Central lines in pediatric ALL patients are associated with a substantial risk of infection.
- Age and treatment protocol are the primary determinants of infection risk for first-line catheters.
- Delaying catheter insertion beyond three weeks from diagnosis did not demonstrably lower the infection risk.
Background:
We compared the rates of infection in external catheters (ECs) and totally implantable devices (TIDs) and the effect of timing of insertion in children with acute lymphoblastic leukemia (ALL).
Procedure:
Central line data was collected on all children with ALL referred to the National Guard Hospital, Jeddah. Data was collected retrospectively from 1996 to September 1999 and prospectively thereafter. Only ECs were inserted prior to 1999 subsequently TIDs were preferred.
Results:
One hundred forty eight children with ALL, mean age 5.1 years had 129 ECs and 70 TIDs inserted for a total of 41,382 catheter days. The overall rate of infective episodes (infections/1,000 catheter days) was 3.43. Of the initial 148 lines 100 developed complications of which 76 (51%) were secondary to an infective episode. Only young age and treatment protocol were risk factors for first line infections (P < 0.05). There was weak evidence that ECs had an earlier time to infection compared to TIDs (P = 0.056).
Conclusions:
In this study, population central lines were associated with a high rate of infection. Treatment protocol and age were the only significant risk factors when only first lines were considered. Delaying catheter insertion for more than 3 weeks from diagnosis did not reduce the risk of infection.
