Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Centre, Houston, TX 77030, USA.
Clin Microbiol Infect. 2011 Nov;17(11):1711-6. doi: 10.1111/j.1469-0691.2011.03504.x. Epub 2011 May 20.
Gram-negative bacillary bacteraemia (GNB) is associated with high morbidity and mortality among cancer patients. We conducted this study to determine the risk factors that may predict the catheter as the source of GNB in cancer patients. From July 2005 to December 2006 all 266 cancer patients with GNB and central venous catheters (CVCs) at The University of Texas M. D. Anderson Cancer Centre in Houston, were classified as catheter-related bloodstream infection (CRBSI) according to Infectious Diseases Society of America criteria. We compared clinical and microbiological features of CRBSIs and non-CRBSIs. We identified 78 CRBSIs and 126 non-CRBSIs. On univariate analysis, polymicrobial bacteraemia, Stenotrophomonas maltophilia bacteraemia, and more than 1000 CFUs in CVC blood cultures, were more common among CRBSI cases. Escherichia coli bacteraemia, haematologic cancer, neutropenia and prior antibiotic use were more common among non-CRBSI cases. On multivariate analysis, S. maltophilia bacteraemia (odds ratio (OR), 5.78; 95% confidence interval (CI), 1.47-22.78; p 0.045), polymicrobial bacteraemia (OR, 4.04; 95% CI, 1.56-10.44; p 0.042), and more than 1000 CFUs from CVC blood cultures (OR, 4.39; 95% CI, 2.02-9.27; p <0.01), were associated with CRBSI. Neutropenia was associated with non-CRBSI (OR, 0.26; 95% CI, 0.13-0.53; p <0.01). Several factors such as S. maltophilia bacteraemia, polymicrobial bacteraemia and more than 1000 CFUs from a blood culture drawn through the CVC may assist the clinicians in assessing whether an indwelling catheter is the source of a GNB and hence CVC removal may be considered.
革兰氏阴性杆菌菌血症（GNB）与癌症患者的高发病率和死亡率有关。我们进行这项研究，以确定可能预测癌症患者 GNB 导管来源的危险因素。从 2005 年 7 月至 2006 年 12 月，休斯顿德克萨斯大学 M.D.安德森癌症中心所有 266 例患有 GNB 和中央静脉导管（CVC）的癌症患者，根据传染病学会的标准被分类为导管相关血流感染（CRBSI）。我们比较了 CRBSI 和非 CRBSI 的临床和微生物学特征。我们确定了 78 例 CRBSI 和 126 例非 CRBSI。在单变量分析中，多微生物菌血症、嗜麦芽窄食单胞菌菌血症和 CVC 血培养中超过 1000CFU，在 CRBSI 病例中更为常见。大肠杆菌菌血症、血液系统癌症、中性粒细胞减少症和先前使用抗生素在非 CRBSI 病例中更为常见。多变量分析显示，嗜麦芽窄食单胞菌菌血症（比值比（OR），5.78；95%置信区间（CI），1.47-22.78；p=0.045）、多微生物菌血症（OR，4.04；95%CI，1.56-10.44；p=0.042）和 CVC 血培养中超过 1000CFU（OR，4.39；95%CI，2.02-9.27；p<0.01）与 CRBSI 相关。中性粒细胞减少症与非 CRBSI 相关（OR，0.26；95%CI，0.13-0.53；p<0.01）。一些因素，如嗜麦芽窄食单胞菌菌血症、多微生物菌血症和 CVC 抽取的血培养中超过 1000CFU，可能有助于临床医生评估留置导管是否为 GNB 的来源，因此可能需要考虑去除 CVC。
