Dalhousie University.
Can J Infect Dis Med Microbiol. 2007 Jul;18(4):253-6. doi: 10.1155/2007/719794.
Hematopoietic stem cell transplant (HSCT) recipients are at a high risk for late bloodstream infection (BSI). Controversy exists regarding the benefit of surveillance blood cultures in this immunosuppressed population. Despite the common use of this practice, the practical value is not well established in non-neutropenic children following HSCT.
At the IWK Health Centre (Halifax, Nova Scotia), weekly surveillance blood cultures from central lines are drawn from children following HSCT until the line is removed. A retrospective chart review was performed to determine the utility and cost of this practice. Eligible participants were non-neutropenic HSCT recipients with central venous access lines. The cost of laboratory investigations, nursing time, hospital stay and interventions for positive surveillance cultures was calculated.
Forty-three HSCTs were performed in 41 children. Donors were allogenic in 33 cases (77%) and autologous in 10 cases (23%). There were 316 patient contacts for surveillance cultures (mean seven per patient) and 577 central line lumens sampled. Three of 43 patients (7%) had clinically significant positive surveillance blood cultures. Bacteria isolated were Klebsiella pneumoniae (n=2) and Corynebacterium jeikeium (n=1). All follow-up cultures before initiation of antimicrobial therapy were sterile. All three patients were admitted for antimicrobial therapy if they were not already hospitalized and/or had an uncomplicated course. The estimated total cost of BSI surveillance and management of asymptomatic infection over six years was $27,989.
The present study suggests that BSI surveillance in children following HSCT engraftment has a very low yield and significant cost. It is unclear whether it contributes to improved patient outcomes.
造血干细胞移植（HSCT）受者发生晚期血流感染（BSI）的风险较高。在这种免疫抑制人群中，监测血培养的益处存在争议。尽管这种做法很常见，但在 HSCT 后的非中性粒细胞减少儿童中，其实际价值尚未得到很好的确定。
在 IWK 健康中心（新斯科舍省哈利法克斯），从接受 HSCT 的儿童的中央静脉导管中每周抽取一次监测血培养，直到导管被移除。进行了回顾性图表审查，以确定这种做法的效用和成本。合格的参与者是非中性粒细胞减少的 HSCT 受者，且有中心静脉通路。计算了实验室检查、护理时间、住院时间和阳性监测培养物的干预措施的成本。
41 名儿童中有 43 例进行了 HSCT。供体均为异基因 33 例（77%），自体 10 例（23%）。共进行了 316 次监测培养的患者接触（平均每位患者 7 次）和 577 次中心静脉腔采样。43 例患者中有 3 例（7%）的监测血培养呈临床显著阳性。分离的细菌为肺炎克雷伯菌（n=2）和 Corynebacterium jeikeium（n=1）。在开始使用抗生素治疗之前，所有的随访培养均为无菌。如果患者尚未住院且/或无并发症，则所有 3 例患者均接受抗生素治疗。六年内 BSI 监测和无症状感染管理的总费用估计为 27989 美元。
本研究表明，HSCT 植活后儿童 BSI 监测的检出率很低，成本很高。目前尚不清楚它是否有助于改善患者的结局。
