Association of Prophylactic Antibiotics With Early Infectious Complications in Children With Cancer Undergoing Central Venous Access Device Placement.

IF 7.5 1区医学 Q1 SURGERY Annals of surgery Pub Date : 2024-12-01 Epub Date: 2023-10-23 DOI:10.1097/SLA.0000000000006140

Steven T Papastefan, Suhail Zeineddin, Martin L Blakely, Harold N Lovvorn, Lynn Wei Huang, Mehul V Raval, Timothy B Lautz

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Abstract

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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预防性抗生素与癌症儿童中心静脉穿刺置管早期感染并发症的相关性。

目的：评价预防性抗生素对癌症儿童中心静脉通路装置（VAD）置入后早期感染性并发症的影响。背景数据摘要：尽管VAD手术在儿童中的频率很高，但预防性抗生素在减少感染并发症方面的有效性尚不清楚。方法：这是一项回顾性队列研究，研究对象为2017-2021年间在儿科健康信息系统数据库中确定的接受中心VAD植入的癌症儿童。主要结果是早期感染并发症（复合手术部位感染、中心线相关血流感染和菌血症）的发生率。多变量逻辑回归用于评估与早期感染相关的因素，并比较各亚组预防性抗生素治疗效果的异质性。结果：包括9216名患者（6058个端口和3158条隧道线路）。预防性抗生素总体上与较低的早期感染并发症相关（1.3%对2.4%；OR 0.55[95%C.I.0.39-0.79]结论：预防性抗生素与中心VAD植入后早期感染并发症的减少有关。尽管多个国家组织建议不要使用预防性抗生素，但这些发现表明，对接受隧道线植入的恶性肿瘤儿童有益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.