A prospective analysis of vascular access device-related infections in children

To identify significant predictors of device-related infections, we performed a prospective, nonrandomized analysis of our experience with vascular access devices over a 2-year period in a pediatric oncology population. Variables analyzed included: (1) age at placement, (2) sex, (3) underlying disease, (4) type of device used (catheter v port), and (5) total white blood cell count at placement. Quantitative microbiologic criteria were used for diagnosis of bacteremia while clinical and microbiologic criteria were used in diagnosis of tunnel/port/site infections. During the study period a total of 351 devices, comprising 78, 159 days in situ, were placed and data for univariate and multivariate analysis were available on 271 (77%). The mean age at placement was 7.2 ± 4.7 years for catheters and 9.5 ± 4.8 years for implantable devices ( P ≤ .01). Significant predictors of device-related infections in univariate analysis were type of device ( P ≤ .0001) and age ( P ≤ .002). External catheters and age ≤ 7 years were associated with increased risk of infection. Underlying disease had a marginal effect on the infection rate ( P = .08). In multivariate analysis, device type ( P ≤ .0001) and age ( P ≤ .002) continued to affect infections, whereas underlying disease demonstrated only a borderline effect ( P = .14). We conclude that device type and age significantly affect the rate of device-related infections. These data support increased use of implantable devices in pediatric oncology patients.