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Association of Prophylactic Antibiotics With Early Infectious Complications in Children With Cancer Undergoing
Steven T Papastefan1, Suhail Zeineddin1, Martin L Blakely2
1Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
Prophylactic antibiotics reduce early infections after central venous access device placement in children with cancer, particularly for tunneled lines. This finding contrasts with current guidelines, suggesting a potential benefit for this patient group.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Medical Devices
Background:
- Central venous access devices (VADs) are crucial for pediatric cancer treatment.
- Infectious complications post-VAD placement pose significant risks.
- The role of prophylactic antibiotics in VAD procedures for children remains unclear.
Purpose of the Study:
- To assess the impact of prophylactic antibiotics on early infectious complications following central VAD placement in pediatric cancer patients.
- To identify factors influencing infection risk and evaluate antibiotic effectiveness across subgroups.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database (2017-2021).
- Inclusion of pediatric cancer patients undergoing central VAD placement (ports and tunneled lines).
- Primary outcome: composite rate of early infectious complications (surgical site infections, CLABSIs, bacteremia).
- Multivariable logistic regression analysis to determine associated factors and treatment effect heterogeneity.
Main Results:
- Overall, prophylactic antibiotics were linked to a reduction in early infectious complications (1.3% vs. 2.4%, OR 0.55).
- This benefit was observed for tunneled lines (OR 0.59) but not for ports (OR 3.01).
- Multivariate analysis confirmed reduced infection odds with prophylactic antibiotics (OR 0.67) and solid tumors (OR 0.38), while tunneled lines (OR 20.78) and AML (OR 2.37) increased odds.
Conclusions:
- Prophylactic antibiotics are associated with decreased early infectious complications after central VAD placement in children with cancer.
- Findings suggest a benefit of prophylactic antibiotics for tunneled line placement in this population, contrary to some national guidelines.
- Further research may be warranted to refine antibiotic use recommendations for pediatric VAD procedures.
Objective:
To evaluate the impact of prophylactic antibiotics on early infectious complications after central venous access device (VAD) placement in children with cancer.
Background:
Despite the frequency of VAD procedures in children, the effectiveness of prophylactic antibiotics for reducing infectious complications is unknown.
Methods:
This was a retrospective cohort study of children with cancer undergoing central VAD placement identified in the Pediatric Health Information System database between 2017 and 2021. The primary outcome was the rate of early infectious complications (composite surgical site infections, central line-associated bloodstream infections, and bacteremia). Multivariable logistic regression was used to evaluate factors associated with early infection, and heterogeneity of treatment effect of prophylactic antibiotics was compared across subgroups.
Results:
A total of 9216 patients were included (6058 ports and 3158 tunneled lines). Prophylactic antibiotics were associated with lower early infectious complications overall [1.3% vs 2.4%; odds ratio (OR): 0.55 (95% CI: 0.39-0.79), P < 0.001], an effect demonstrated for tunneled lines (OR: 0.59, 95% CI: 0.41-0.84) but not ports (OR: 3.01, 95% CI: 0.66-13.78). On multivariate analysis, prophylactic antibiotics (OR: 0.67, 95% CI: 0.45-0.97) and solid tumors (OR: 0.38, 95% CI: 0.22-0.64) were associated with reduced odds of early infections, whereas tunneled lines (OR: 20.78, 95% CI: 9.83-43.93) and acute myelogenous leukemia (OR: 2.37, 95% CI: 1.58-3.57) had increased odds.
Conclusions:
Prophylactic antibiotics are associated with reduced early infectious complications after central VAD placement overall. Despite recommendations from multiple national organizations against prophylactic antibiotics, these findings suggest a benefit in children with malignancy undergoing tunneled line placement.
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