George Biju, Mathews Vikram, Viswabandya Auro, Srivastava Alok, Chandy Mammen
Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India.
Pediatr Transplant. 2006 Feb;10(1):48-54. doi: 10.1111/j.1399-3046.2005.00397.x.
We studied the clinical profile of infections among 221 pediatric patients who underwent 230 allogeneic transplants between 1986 and June 2004. All patients developed febrile neutropenia. There were 283 documented infections, which included bacterial (36.9%), viral (45.7%), fungal (11.1%) and other infections (6.3%) including tuberculosis. Bacterial and fungal infections were more common in the first 30 days following BMT, while viral infections were more common >30 days after BMT. Bacterial pathogens were predominantly gram-negative organisms (72.7%), when compared with gram-positive organisms (27.3%). Common gram-negative organisms included NFGNB, Pseudomonas, Escherichia coli and Klebsiella while coagulase negative Staphylococci was the main gram-positive organism. Bacteremia (61.2%) was the main source positive cultures and was mainly because of gram-negative organisms (81%), predominantly NFGNB and Pseudomonas. Exactly 103/221(43.7%) transplants had 128 documented viral infections commonly because of Cytomegalovirus, Herpes group of viruses and transfusion related hepatitis. Thirty of 221 (13.5%) of transplants had 30 documented fungal infections with the majority being because of aspergillus (90%). Tuberculosis was seen in 1.7% of transplants while catheter infections were seen in 21 patients (9.1%). Infection related mortality was seen in 12% predominantly because of CMV or fungal infections. A sub group analysis (pre-1998 vs. post-1998) revealed higher incidences of gram-negative infections, bacteremia and bacterial infection related mortality in the pre-1998 era when compared with the recent times. The profile and mortality of infections in this series from India is not significantly different from reports from the West.
我们研究了1986年至2004年6月期间接受230例同种异体移植的221例儿科患者的感染临床特征。所有患者均出现发热性中性粒细胞减少。记录在案的感染有283例，包括细菌感染（36.9%）、病毒感染（45.7%）、真菌感染（11.1%）以及其他感染（6.3%，包括结核病）。细菌和真菌感染在骨髓移植后的前30天更为常见，而病毒感染在骨髓移植后30天以上更为常见。与革兰氏阳性菌（27.3%）相比，细菌病原体主要是革兰氏阴性菌（7**2.7%）。常见的革兰氏阴性菌包括非发酵革兰氏阴性菌、铜绿假单胞菌、大肠杆菌和克雷伯菌，而凝固酶阴性葡萄球菌是主要的革兰氏阳性菌。菌血症（61.2%）是阳性培养物的主要来源，主要是由于革兰氏阴性菌（81%），主要是非发酵革兰氏阴性菌和铜绿假单胞菌。确切地说，103/221（43.7%）的移植患者有128例记录在案的病毒感染，通常是由于巨细胞病毒、疱疹病毒组和输血相关肝炎。221例移植患者中有30例（13.5%）有30例记录在案的真菌感染，大多数是由于曲霉菌（90%）。1.7%的移植患者出现结核病，21例患者（9.1%）出现导管感染。感染相关死亡率为12%，主要是由于巨细胞病毒或真菌感染。亚组分析（1998年前与1998年后）显示，与近期相比，1998年前革兰氏阴性菌感染、菌血症和细菌感染相关死亡率更高。该印度系列研究中的感染特征和死亡率与西方的报告没有显著差异。
