Implantable chest port placement in young patients with severe neutropenia

To determine if severe neutropenia (absolute neutrophil count (ANC) ≤500 cells/mm3) at the time of chest port insertion was a risk factor for central-line associated bloodstream infection (CLABSI) in young patients with malignancy. We also evaluated the incidence of port removal. This was a retrospective study in young patients with various malignancies who had a port inserted from May 2007 to June 2015. Patient malignancy type, ANC prior to port placement, port insertion data, and follow up until port removal or death were reviewed. CLABSI events were evaluated. CDC definitions of CLABSI were used. 191 ports were inserted. 12 patients transferred care to outside facilities or were otherwise lost to follow up. Nearly all of the severely neutropenic patients had B or T cell acute lymphoblastic leukemia (97.1%), while the non-severely neutropenic patient group had more varied diagnoses. The difference in total CLABSI rate was not statistically significant between severely neutropenic patients (21.4%; n=70) and non-severely neutropenic patients (19.3%; n=109) (p=0.726). However, the rate of CLABSI within 30 days of port placement was significantly higher in severely neutropenic patients (14.3%) than in non-severely neutropenic patients (5.5%) (p=0.044). Ports were less frequently removed for CLABSI from patients with severe neutropenia (2.9% ports removed) than from patients without severe neutropenia (10.1% ports removed), although this difference did not achieve statistical significance (p=.069). The difference in rate of port removal for infection within 30 days of placement was not statistically significant between the two groups (2.9% vs 2.8%; p=0.968). The most common causative organism was Staphylococcus aureus in non-severely neutropenic patients, and Psuedomonas aeruginosa in severely neutropenic patients. Severe neutropenia increases the risk of CLABSI within 30 days of port placement, but the rate of port removal during the first 30 days in this patient group was similar to non-severely neutropenic patients. In addition, the total rate of CLABSI between severely neutropenic and non-severely neutropenic patients was not significantly different after 30 days.