Department of Diagnostic Imaging-Image Guided Therapy Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
Cancer. 2010 Sep 15;116(18):4368-75. doi: 10.1002/cncr.25286.
The objective of this study was to determine whether severe neutropenia on the day of port-a-catheter (PORT) insertion was a risk factor for catheter-associated infection (CAI) in children with acute lymphoblastic leukemia (ALL).
This was a retrospective study of children with ALL who had a PORT insertion between January 2005 and August 2008. Early (≤ 30 days) and late (>30 days) postprocedure complications were reviewed. The length of follow-up ranged between 7 months and 42 months.
In total, 192 PORTs were inserted in 179 children. There were 43 CAIs (22%), and the infection rate was 0.35 per 1000 catheter-days. The CAI rate (15%) in children who had severe neutropenia on the day of the procedure did not differ statistically from the CAI rate (24%) in children who did not have severe neutropenia (P = .137). Conversely, patients with severe neutropenia who had a CAI were more likely to have their PORT removed (P = .019). The most common organisms to cause catheter removal were coagulase-negative Staphylococcus and Staphylococcus aureus. Patients with high-risk ALL had a statistically significant higher incidence of late CAI than patients with standard-risk ALL (P = .012). Age (P = .272), positive blood culture preprocedure (P = 1.0), and dexamethasone use (P = .201) were not risk factors for CAI. Patients who had an early CAI did not have a greater chance of having a late CAI. The catheter infection-free survival rate at 1 year was 88.6%.
The current results indicated that severe neutropenia on the day of PORT insertion does not increase the risk of CAI in children with ALL.
本研究旨在确定在 PORT 置入当天是否发生严重中性粒细胞减少症是否是儿童急性淋巴细胞白血病（ALL）患者发生导管相关性感染（CAI）的危险因素。
这是一项回顾性研究，纳入 2005 年 1 月至 2008 年 8 月期间接受 PORT 置入的 ALL 患儿。回顾了早期（≤ 30 天）和晚期（>30 天）术后并发症。随访时间为 7 个月至 42 个月。
共 179 例患儿接受了 192 次 PORT 置入。发生了 43 例 CAI（22%），感染率为 0.35 例/1000 导管日。行 PORT 置入当天发生严重中性粒细胞减少症的患儿的 CAI 发生率（15%）与未发生严重中性粒细胞减少症的患儿（24%）相比，无统计学差异（P =.137）。相反，发生 CAI 的严重中性粒细胞减少症患儿更有可能拔除 PORT（P =.019）。导致 PORT 拔除的最常见病原体为凝固酶阴性葡萄球菌和金黄色葡萄球菌。高危 ALL 患儿的晚期 CAI 发生率显著高于低危 ALL 患儿（P =.012）。年龄（P =.272）、置管前血培养阳性（P = 1.0）和使用地塞米松（P =.201）不是 CAI 的危险因素。发生早期 CAI 的患儿发生晚期 CAI 的可能性并未增加。1 年时导管无感染生存率为 88.6%。
目前的结果表明，在 PORT 置入当天发生严重中性粒细胞减少症不会增加 ALL 患儿发生 CAI 的风险。
