Children with Leukemia and Fever at Diagnosis: Bloodstream Infection and Central Venous Access Device Removal.

PURPOSE: To assess the incidence of fever at diagnosis in children with leukemia and to determine if fever at diagnosis is a predictor of BSI or CVAD removal due to infection either within the first 30 days or between 30- and 90-days post CVAD insertion.

MATERIALS AND METHOD: 151 acute leukemia patients (July 1, 2018 to December 31, 2020), who had a CVAD insertion within 2 weeks of diagnosis were included. Demographics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1000 catheter days, and need for line removal post CVAD insertion within 30 days and between 30 and 90 days.

RESULTS: Patients with fever at diagnosis had a significantly higher incidence of BSI within the first 30-days post CVAD insertion (17/23) than patients without fever (6/23)(p=0.046). No statistically significant difference in the incidence of BSI between 30- and 90-days post CVAD insertion between patients with fever (5/11) and those without fever (6/11) (p=0.519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients require CVAD removal; 7/9 had fever and 2/9 had no fever) (p=0.181) or between 30 and 90 days (4 patients require CVAD removal;1/4 had fever and 3/4 had no fever at diagnosis)(p=0.343) post insertion.

CONCLUSION: Fever in leukemia patients at diagnosis is not a predictor of CVAD removal due to infection.