AUSTIN, Texas -- It may be possible to reduce care-related infections in children with leukodystrophies using standardized prevention efforts in the hospital setting, researchers reported here.
Children with leukodystrophies were found to have high rates of infection associated with a number of causes: not getting a yearly flu vaccine (OR 6.4), sepsis related to a central line (OR 9.8), urinary tract infection from a urinary catheter (OR 9.0), and pneumonia related to ventilator hardware (OR 2.7), according to Holly Anderson, MSII, of the University of Utah in Salt Lake City, and colleagues.
- This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"Leukodystrophies are very serious diseases of the central nervous system. We wanted to implement an evidence-based method for creating a standard of care for leukodystrophy patients," Anderson said at the annual meeting of the Child Neurology Society.
She and her colleagues found that 81% of the high costs involved with treating patients with leukodystrophies are associated with hospitalizations. For the most part, hospitalizations become necessary when a patient develops an infection, requires mechanical ventilation, or is admitted into the intensive care unit (ICU).
On average, hospitalization and treatment-related costs exceed $100,000 per leukodystrophy patient.
The researchers looked at the charts of 160 children with leukodystrophies from 1999 to 2013. Among the 160 patients, 75 developed a total of 232 hospitalization-related infections.
The most common infections identified were pneumonia (developed by 28% of patients), sepsis (28%), bronchiolitis (19%), urinary tract infection (14%) and influenza (9%). Also common were cellulitis or soft tissue infection, and meningitis.
"We wanted to analyze the difference between bone marrow transplant patients and non-bone marrow transplant patients. Because bone-marrow transplant patients are so immunocompromised, we thought that maybe they would have a much higher infection rate than the nonbone marrow transplant patients. But nonbone marrow transplant patients developed as many infections as the bone marrow transplant patients," Anderson said.
The only gap in infections between the bone marrow transplant and the non-bone marrow transplant group had to do with sepsis (54% versus 21%).
Sepsis infections were associated with central lines (OR 9.8), urinary catheters (OR 3.7), and in-dwelling hardware (OR 1.7). UTIs were associated with in-dwelling urinary catheters (OR 9.0).
Catching the flu was associated with not receiving a yearly vaccine (OR 6.4). A higher risk of pneumonia was associated with having a tracheostomy and/or ventilator (OR 2.7). All of the risk factors were considered to be statistically significant.
Anderson and colleagues suggested administering the flu vaccine every year, better care for in-dwelling IV lines, in-dwelling hardware, urinary catheters, tracheostomies, and ventilators, and providing more aggressive preventive care for patients with bulbar insufficiency and bone marrow transplant.
"Hospitalized leukodystrophy patients have modifiable risk factors for infection. Addressing these risk factors can significantly reduce the hospitalizations and improve patient and family care and life," Anderson said.
Anderson was supported by the National Institutes of Health. Bonkowsky was supported by the National Institutes of Health, the Vanishing White Matter Foundation, and the Primary Medical Center Foundation. The authors reported no financial disclosures.
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