Krenn T, Fleischhack G, Moser O, Dilloo D, Bode U, Gräber S, Furtwängler R, Graf N, Simon A
Department of Paediatric Oncology and Haematology, University Hospital, Homburg/Saar, Germany.
Klin Padiatr. 2011 Nov;223(6):335-40. doi: 10.1055/s-0031-1287838. Epub 2011 Oct 19.
Preventive approaches (including those related to care of long term central venous catheters, CVADs) and the incidence of bloodstream infections (BSI) in 2 German university affiliated paediatric oncology units.
Non-interventional prospective observational study using the Oncoped surveillance module. Center A included 85 patients in 31 months and Center B 84 patients in 21 months. The populations did not differ in terms of age, gender, malignancy and disease status (first illness vs. relapse). Center A used ports (46 %) and 2 different Broviac catheters (54 %), in Center B nearly all patients with a CVAD had Broviacs (96 %). 30 BSI (24 patients) were diagnosed in Centre A and 28 BSI (22 patients) in Center B. Patients with relapsed malignancy experienced more BSI (51.4 % vs. 20.9 %; p = 0.001). Incidence rates were significantly lower in Center A (3.47 vs. 7.93 BSI/1000 CVAD days; p = 0.037). Poisson regression analysis revealed a significant lower incidence density (BSI/100 inpatient days) for all BSI in Center A (RR 0.47 CI95 0.27-0.81, p = 0.006). Overall, 52 % of all pathogens detected in blood cultures in Center A were Gram-positive (57 % in Center B) and 48 % Gram-negative (43 in Center B). One ALL patient without a CVAD died due to overwhelming sepsis caused by an ESBL-producing E. cloacae isolate.
Paediatric cancer treatment centers differ substantially in regard to management of CVADs and in other preventive strategies. The most important use of local surveillance data is longitudinal internal assessment in close cooperation with microbiology and hospital hygiene experts.
德国两家大学附属医院儿科肿瘤病房的预防措施（包括与长期中心静脉导管护理相关的措施）及血流感染（BSI）发生率。
采用肿瘤护理监测模块进行非干预性前瞻性观察研究。中心A在31个月内纳入85例患者，中心B在21个月内纳入84例患者。两组人群在年龄、性别、恶性肿瘤类型及疾病状态（初发疾病与复发）方面无差异。中心A使用植入式静脉输液港（46%）和2种不同的 Broviac 导管（54%），中心B几乎所有置有中心静脉导管（CVAD）的患者均使用 Broviac 导管（96%）。中心A诊断出30例BSI（24例患者），中心B诊断出28例BSI（22例患者）。复发恶性肿瘤患者发生BSI的比例更高（51.4%对20.9%；p = 0.001）。中心A的发生率显著更低（3.47对7.93例BSI/1000 CVAD日；p = 0.037）。泊松回归分析显示中心A所有BSI的发病密度（BSI/100住院日）显著更低（相对危险度0.47，95%可信区间0.27 - 0.81，p = 0.006）。总体而言，中心A血培养中检测到的所有病原体有52%为革兰阳性菌（中心B为57%），48%为革兰阴性菌（中心B为43%）。1例未置CVAD的急性淋巴细胞白血病（ALL）患者因产超广谱β-内酰胺酶（ESBL）的阴沟肠杆菌分离株导致的严重脓毒症死亡。
儿科癌症治疗中心在CVAD管理及其他预防策略方面存在显著差异。当地监测数据的最重要用途是与微生物学及医院感染控制专家密切合作进行纵向内部评估。
