Simon A, Fleischhack G, Hasan C, Bode U, Engelhart S, Kramer M H
Department of Pediatric Hematology and Oncology, University of Bonn, Germany.
Infect Control Hosp Epidemiol. 2000 Sep;21(9):592-6. doi: 10.1086/501809.
To determine the incidence of all nosocomial infections (NIs) in pediatric hematology-oncology patients, as well as central venous access device (CVAD)-associated infections acquired during home care.
Prospective surveillance study.
The Pediatric Hematology and Oncology Department at the University Hospital Bonn.
All patients admitted from January through October 1998 (surveillance period).
Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System.
A total of 143 patients were hospitalized for 3,701 days (776 admissions) during the surveillance period. Of the 40 NIs detected, 26 were CVAD-related, with 21 bloodstream infections (BSIs) and 5 local infections. Four were Clostridium difficile-associated diarrheal illnesses, 3 were pneumonias, and 7 were other infections. The incidence of NIs was 10.8 per 1,000 patient-days (5.2 NIs/100 admissions). The overall CVAD-related BSI rate was 7.4 per 1,000 utilization days, without a significant difference between implanted infusion ports and tunneled catheters. In addition, 7 CVAD-related infections occurred during home care. All 8 BSIs associated with tunneled catheters and 13 (76%) of the 17 BSIs associated with ports were acquired nosocomially. For inpatients and outpatients combined, the exit sites of tunneled catheters were more likely to become locally infected than were the needle entry sites of ports (relative risk, 8.0; P=.007). In 30 (75%) of the 40 NIs, the affected patients had severe neutropenia (<500/mm3) at the time of infection.
Most NIs in the pediatric hematology-oncology patients were associated with CVAD devices. Although many infections in this high-risk population may not be preventable through infection control measures, the careful evaluation of specific infection rates permits the identification of risk factors that may be targeted by infection control programs. Prospective surveillance for NIs on pediatric oncology units is an indispensable tool for this internal quality control.
确定儿科血液肿瘤患者中所有医院感染（NI）的发生率，以及家庭护理期间获得的中心静脉通路装置（CVAD）相关感染的发生率。
前瞻性监测研究。
波恩大学医院儿科血液学和肿瘤学系。
1998年1月至10月期间收治的所有患者（监测期）。
基于美国疾病控制与预防中心国家医院感染监测系统的标准化监测系统。
在监测期内，共有143名患者住院3701天（776次入院）。在检测到的40例NI中，26例与CVAD相关，其中21例为血流感染（BSI），5例为局部感染。4例为艰难梭菌相关性腹泻病，3例为肺炎，7例为其他感染。NI的发生率为每1000患者日10.8例（每100次入院5.2例NI）。CVAD相关的总体BSI率为每1000使用日7.4例，植入式输液港和隧道式导管之间无显著差异。此外，家庭护理期间发生了7例与CVAD相关的感染。与隧道式导管相关的所有8例BSI以及与输液港相关的17例BSI中的13例（76%）是在医院获得的。对于住院患者和门诊患者合并而言，隧道式导管的出口部位比输液港的穿刺部位更易发生局部感染（相对风险，8.0；P = 0.007）。在40例NI中的30例（75%）中，受影响患者在感染时患有严重中性粒细胞减少症（<500/mm³）。
儿科血液肿瘤患者中的大多数NI与CVAD装置相关。尽管通过感染控制措施可能无法预防该高危人群中的许多感染，但对特定感染率的仔细评估有助于识别感染控制计划可能针对的危险因素。对儿科肿瘤病房的NI进行前瞻性监测是这种内部质量控制不可或缺的工具。
