Dettenkofer M, Ebner W, Bertz H, Babikir R, Finke J, Frank U, Rüden H, Daschner F D
Institute of Environmental Medicine and Hospital Epidemiology, University Hospital of Freiburg, Germany.
Bone Marrow Transplant. 2003 May;31(9):795-801. doi: 10.1038/sj.bmt.1703920.
To identify overall and site-specific rates of nosocomial infections (NIs) during the neutropenic, as compared to the non-neutropenic stage of treatment in adult recipients of allogeneic and autologous bone marrow transplantation (BMT) and peripheral blood stem-cell transplantation (PBSCT), a prospective, 54-month study was started at the Haematological Stem Cell Transplantation Unit of the University Hospital of Freiburg, Germany. NI types were identified using modified CDC definitions. A total of 351 patients (14 256 in-patient days, 5026 neutropenic days) were investigated (316/90% allogeneic, 35/10% autologous; BMT: 119 patients, PBSCT: 234 patients). The mean length of neutropenia was 14.3 days (range: 0-66). Antimicrobial prophylaxis for allogeneic transplantation consisted of ciprofloxacin, trimethoprim/sulpha-methoxazole, fluconazole, and metronidazole. In total, 239 NIs were identified in 169 patients (48.1%), and of these 171 (71.5%) occurred during neutropenia (34.0 NIs per 1000 days at risk). The main pathogens were coagulase-negative staphylococci (36.3%), Clostridium difficile (20.4%), and enterococci (10.0%). Site-specific incidence densities during neutropenia vs non-neutropenia were: 13.9 vs 1.6 bloodstream infections (all central line-associated), 11.9 vs 1.8 pneumonias, 3.0 vs 2.9 gastroenteritis, and 1.6 vs 0.3 urinary tract infections. The greatest number of NI in BMT and PBSCT recipients is acquired during neutropenia, and multicentre surveillance programmes should focus on this.
为了确定异基因和自体骨髓移植（BMT）及外周血干细胞移植（PBSCT）成年受者中性粒细胞减少期与非中性粒细胞减少期治疗期间医院感染（NI）的总体发生率和特定部位发生率，德国弗莱堡大学医院血液干细胞移植科开展了一项为期54个月的前瞻性研究。采用修改后的美国疾病控制与预防中心（CDC）定义来识别NI类型。共调查了351例患者（住院日14256天，中性粒细胞减少日5026天）（316例/90%为异基因移植，35例/10%为自体移植；BMT：119例患者，PBSCT：234例患者）。中性粒细胞减少的平均时长为14.3天（范围：0 - 66天）。异基因移植的抗菌预防用药包括环丙沙星、甲氧苄啶/磺胺甲恶唑、氟康唑和甲硝唑。总共在169例患者（48.1%）中识别出239例NI，其中171例（71.5%）发生在中性粒细胞减少期（每1000天危险日有34.0例NI）。主要病原体为凝固酶阴性葡萄球菌（36.3%）、艰难梭菌（20.4%）和肠球菌（10.0%）。中性粒细胞减少期与非中性粒细胞减少期特定部位的发病密度分别为：血流感染（均与中心静脉导管相关）13.9例对1.6例，肺炎11.9例对1.8例，肠胃炎3.0例对2.9例，尿路感染1.6例对0.3例。BMT和PBSCT受者中大多数NI是在中性粒细胞减少期获得的，多中心监测项目应关注这一点。
