Hematology and Oncology Unit, Mansoura University Children's Hospital, Nile Delta, Egypt.
World J Pediatr. 2011 Feb;7(1):60-4. doi: 10.1007/s12519-010-0212-1. Epub 2010 Jun 12.
pediatric hematology/oncology patients are faced with an increased risk of nosocomial infections (NIs) that vary in different populations and different institutions with considerable morbidity and mortality. This study was undertaken to assess the frequency and patterns of NIs in 1564 pediatric patients and to determine the prevalence of causative organisms and their antimicrobial sensitivity.
a retrospective analysis was made in the patients admitted between January 2007 and January 2008 to the pediatric hematoloy/oncology unit of Mansoura University, Egypt. The 1564 patients showed 2084 admissions and 27 092 inpatient days. The Centers for Disease Control and Prevention criteria were used as a standard definition for NI.
the overall rate of NIs in all patients and neutropenic patients was 8.6 and 25.3 per 1000 patient-days respectively. The frequent sites of NIs were blood stream (42.7%), the respiratory system (25.3%), the urinary system (22.2%) and the central nervous system (9.8%), whereas nosocomial fever of unknown origin constituted 52.9% of cases. The incidence of NIs was significantly higher during neutropenic days (P<0.001). Gram-positive organisms represented 64.5% of pathogens (Staphylococci 71.5%, Streptococci 16%, and pneumococci 7%), and Gram-negative organisms represented 30% (E. coli 48.6%, Klebsiella 15.7%, Pseudomonas 35.7%, and C. albicans 5.5%). Positive cultures were more frequent in summer (July to September). Susceptibility of isolated organisms was relatively low (cefoperazone/sulbactam 49.9%, amikacin 35.9%, imipenem/cilastin 34.4%, cefoperazone 33.6%, and vancomycin 36.5%). Methicillin-resistant S. aureus, extended spectrum beta lactamase and vancomycin resistant enterococci represented 30%, 45% and 75% of isolated S. aureus, Gram-negative organisms and Enterococci, respectively.
blood stream infection and fever of unknown origin are the most common nosocomial infections in pediatric hematology/oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly Gram-positive pathogens with a high incidence of methicillin-resistant S. aureus, extended spectrum beta lactamase and vancomycin resistant enterococci organisms.
儿科血液学/肿瘤学患者面临着医院获得性感染（NI）的风险增加，这种感染在不同人群和不同机构中有所不同，具有相当高的发病率和死亡率。本研究旨在评估 1564 例儿科患者的 NI 发生率和模式，并确定病原体的流行率及其抗菌敏感性。
对 2007 年 1 月至 2008 年 1 月期间在埃及曼苏拉大学儿科血液学/肿瘤学病房住院的患者进行回顾性分析。1564 例患者共 2084 人次住院，27092 天住院。采用美国疾病控制与预防中心的标准定义作为 NI 的标准。
所有患者和中性粒细胞减少症患者的总体 NI 发生率分别为每 1000 患者日 8.6 和 25.3 例。NI 的常见部位为血流（42.7%）、呼吸系统（25.3%）、泌尿系统（22.2%）和中枢神经系统（9.8%），而原因不明的医院获得性发热占病例的 52.9%。中性粒细胞减少症期间的 NI 发生率明显更高（P<0.001）。革兰阳性菌占病原体的 64.5%（葡萄球菌 71.5%，链球菌 16%，肺炎球菌 7%），革兰阴性菌占 30%（大肠埃希菌 48.6%，克雷伯菌 15.7%，铜绿假单胞菌 35.7%，白假丝酵母菌 5.5%）。夏季（7 月至 9 月）的阳性培养物更为频繁。分离出的病原体的药敏率相对较低（头孢哌酮/舒巴坦 49.9%，阿米卡星 35.9%，亚胺培南/西司他丁 34.4%，头孢哌酮 33.6%，万古霉素 36.5%）。耐甲氧西林金黄色葡萄球菌、超广谱β-内酰胺酶和万古霉素耐药肠球菌分别占分离出的金黄色葡萄球菌、革兰阴性菌和肠球菌的 30%、45%和 75%。
血液感染和原因不明的发热是儿科血液学/肿瘤学患者中最常见的医院获得性感染，中性粒细胞减少症期间风险更高。分离出的病原体具有多药耐药性，主要为革兰阳性病原体，耐甲氧西林金黄色葡萄球菌、超广谱β-内酰胺酶和万古霉素耐药肠球菌的发生率较高。
