Paediatric Infectious Diseases Group, St. George's University of London, London, UK.
Pediatr Blood Cancer. 2014 Jul;61(7):1239-45. doi: 10.1002/pbc.24995. Epub 2014 Feb 24.
Cancer is the second most common cause of childhood deaths in the United Kingdom and infection contributes to a quarter of all cancer-related deaths. This study aimed to estimate the risk, aetiology and outcome of bloodstream bacterial and fungal infections in children with cancer within a geographically defined region in South-West London over a 3-year period.
Web-based questionnaires were completed using case records of children with positive blood cultures admitted to five London hospitals during 2009-2011.
A total of 112 children with a median age of 5.4 (IQR 3.6-11.2) years had 266 significant blood cultures during 149 infection episodes. Haematological malignancy affected 68 patients (60.7%) and solid tumours 44 (39.3%). The overall bloodstream infection rate was 1.5 episodes per 1,000 days-at-risk (95% CI, 1.2-1.8) and was similar for those with haematological malignancies and solid tumours. Most episodes were attributed to central venous catheter infection (120/149, 80.5%). Coagulase-negative staphylococci were isolated in almost half the bloodstream infections (127/266; 47.7%), while Gram-negative organisms accounted for a further quarter (64/266; 24.1%). Fungal isolates from blood were uncommon (8/112 children, 7.1%) but significantly associated with neutropenia (18/149 [12.1%] vs. 1/114 [0.9%], P = 0.0004). Six children (5.4%) died, including three (2.7%; 95% CI, 0.6-7.6%) whose deaths were infection-related.
This study provides an updated risk estimate for bloodstream infections in children with cancer and adds to the framework for developing evidence-based guidance for management of suspected infections in this highly vulnerable group.
癌症是英国儿童死亡的第二大常见原因，感染导致四分之一的癌症相关死亡。本研究旨在评估在英国西南部一个地理位置明确的地区，3 年内儿童癌症患者血流细菌和真菌感染的风险、病因和结果。
使用 2009-2011 年期间在伦敦五家医院住院的血培养阳性儿童的病历，通过网络问卷调查。
共有 112 名中位年龄为 5.4（IQR 3.6-11.2）岁的儿童在 149 次感染发作中有 266 次有意义的血培养。血液恶性肿瘤影响 68 例患者（60.7%），实体瘤影响 44 例（39.3%）。总的血流感染率为每 1000 天风险 1.5 次（95%CI，1.2-1.8），血液恶性肿瘤和实体瘤患者的感染率相似。大多数感染是由中心静脉导管感染引起的（120/149，80.5%）。凝固酶阴性葡萄球菌几乎占一半的血流感染（127/266；47.7%），而革兰氏阴性菌占进一步的四分之一（64/266；24.1%）。血液真菌分离物少见（112 名儿童中有 8 例，7.1%），但与中性粒细胞减少显著相关（149 例中的 18 例[12.1%]与 114 例中的 1 例[0.9%]，P = 0.0004）。有 6 名儿童（5.4%）死亡，其中 3 名（2.7%；95%CI，0.6-7.6%）的死亡与感染有关。
本研究提供了儿童癌症患者血流感染的最新风险估计，并为制定这一高度脆弱群体疑似感染管理的循证指南提供了框架。
