Complications in Pediatric Cancer Patients With Staphylococcus aureus Bloodstream Infection
Leonora R Slatnick, Jessica Giles, Tamara P Miller, Jenna Rossoff, Joshua Wolf, Etan Orgel, Monica Ardura, Christopher P Ouellette, Daniel N Willis, Mary Claire McGlynn, Rema A Malone, Emad Salman, Jenna Demedis, Molly Arnstrom, Zhiguo Zhao, Daniel A Whitehurst, Debra L Friedman, Daniel E Dulek, Ritu Banerjee, Adam J EsbenshadeBACKGROUND
Staphylococcus aureus bloodstream infections (BSIs) can cause significant morbidity in children with cancer. Current guidelines recommend central venous catheter (CVC) removal, though the necessity remains uncertain. We assessed risk factors for complications among affected patients, focusing on impact of CVC removal vs salvage.
METHODS
This multicenter retrospective study includes pediatric oncology patients with S aureus BSIs from 2005 to 2022. The complication outcome period (72 hours to 6 months after initial positive culture) was divided into short-term (72 hours to 8 days) and late periods (8 days to 6 months). The composite primary outcome included occurrence of at least 1 major complication: recurrent BSIs, deep abscess/myositis, S aureus–related death, exit site infection, meningitis, endocarditis, or osteomyelitis. Multivariable logistic regression with propensity score weighting for CVC removal was performed.
RESULTS
Among 322 BSI episodes, 90.7% (n = 292/322) had a CVC at presentation; salvage was attempted in 55.5% (n = 162/292). The primary outcome was met in 21.2% (n = 62/292) of episodes with a CVC, more frequently in the CVC salvage (25.3%, n = 41/161) vs removal (16.2%, n = 21/130) group. CVC salvage was independently associated with the primary outcome (OR, 3.37; 95% CI, 2.08–5.61; P < .01) in short-term (OR, 21.8; 95% CI, 7.09–95.4) and late (OR, 1.83; 95% CI, 1.06–3.18) periods. Methicillin resistance, male sex, invasive infection at presentation, implanted ports, sepsis, and persistent blood culture positivity were also independently associated with the primary outcome.
CONCLUSIONS
CVC removal was associated with fewer short-term and late complications in pediatric cancer patients with S aureus BSIs, supporting recommendations for catheter removal in this population.