Laws H J, Schneider D T, Janssen G, Wessalowski R, Dilloo D, Meisel R, Adams O, Mackenzie C, Göbel U
Department of Pediatric Oncology, Hematology and Immunology, Heinrich-Heine-University, Düsseldorf, Germany.
Pediatr Hematol Oncol. 2007 Jul-Aug;24(5):343-54. doi: 10.1080/08880010701391788.
Children with cancer have an overall chance of survival of 70-80%. Despite significant advances in supportive care during the last years, infections remain a major cause of therapy-associated morbidity and death. Between January and December 2000, oncology patients (ONC) treated on a pediatric oncology ward after chemotherapy (n = 109), loco-regional thermochemotherapy (n = 13), or hematopoietic stem cell (HSCT) transplantation (n = 35) suffered a total of 249 febrile infectious complications (HSCT 40/ONC 209). These episodes were analyzed retrospectively and compared with 125 ONC patients with 133 febrile infections in 1980/81. The relative incidence of fever of unknown origin (FUO) decreased from 1980/81 to 2000 (p <.001). The frequency of bloodstream infections (BSI) in febrile episodes was comparable in both periods with 37% (50/135) in 1980 and 29% (72/249) in 2000. In both periods, gram-positive bacteria were the most frequent organisms, whereas gram-negative organisms were detected in approximately 20% of BSI. In 1980/81 microbiologically (MDI) or clinically documented infections (CDI) were not detected, whereas in 2000 27% of all infectious were MDI/CDI. During the last 20 years, improved diagnostic tools have resulted in an increased detection rate of infectious agents causing febrile episodes in pediatric cancer patients. The comparison of the two observation periods did not reveal a change in the microbiologic spectrum. Despite the fact that in 2000 more patients were treated with intensified chemotherapy because of relapse, infection-related mortality was unchanged compared to 1980/81. This observation may indicate a sufficient preemptive antibacterial therapy followed by better diagnostic tools and goal-oriented treatment.
患有癌症的儿童总体生存率为70 - 80%。尽管在过去几年中支持性护理取得了显著进展，但感染仍然是治疗相关发病和死亡的主要原因。在2000年1月至12月期间，在儿科肿瘤病房接受化疗（n = 109）、局部区域热化疗（n = 13）或造血干细胞（HSCT）移植（n = 35）的肿瘤患者共发生了249例发热性感染并发症（HSCT患者40例/化疗患者209例）。对这些病例进行了回顾性分析，并与1980/81年125例发生133例发热性感染的化疗患者进行了比较。不明原因发热（FUO）的相对发生率从1980/81年到2000年有所下降（p <.001）。发热发作中血流感染（BSI）的频率在两个时期相当，1980年为37%（50/135），2000年为29%（72/249）。在两个时期，革兰氏阳性菌都是最常见的病原体，而革兰氏阴性菌在约20%的血流感染中被检测到。在1980/81年未检测到微生物学（MDI）或临床记录的感染（CDI），而在2000年，所有感染中有27%为MDI/CDI。在过去20年中，诊断工具的改进提高了小儿癌症患者发热发作的感染病原体检测率。两个观察期的比较未发现微生物谱有变化。尽管2000年因复发接受强化化疗的患者更多，但与1980/81年相比，感染相关死亡率没有变化。这一观察结果可能表明，在采用更好的诊断工具和目标导向治疗之前，进行了充分的预防性抗菌治疗。
