Ammann R A, Laws H J, Schrey D, Ehlert K, Moser O, Dilloo D, Bode U, Wawer A, Schrauder A, Cario G, Laengler A, Graf N, Furtwängler R, Simon A
Department of Paediatrics, University of Bern, Bern, Switzerland,
Eur J Pediatr. 2015 May;174(5):675-86. doi: 10.1007/s00431-015-2525-5. Epub 2015 Mar 26.
In a prospective multicentre study of bloodstream infection (BSI) from November 01, 2007 to July 31, 2010, seven paediatric cancer centres (PCC) from Germany and one from Switzerland included 770 paediatric cancer patients (58% males; median age 8.3 years, interquartile range (IQR) 3.8-14.8 years) comprising 153,193 individual days of surveillance (in- and outpatient days during intensive treatment). Broviac catheters were used in 63% of all patients and Ports in 20%. One hundred forty-two patients (18%; 95% CI 16 to 21%) experienced at least one BSI (179 BSIs in total; bacteraemia 70%, bacterial sepsis 27%, candidaemia 2%). In 57%, the BSI occurred in inpatients, in 79% after conventional chemotherapy. Only 56 % of the patients showed neutropenia at BSI onset. Eventually, patients with acute lymphoblastic leukaemia (ALL) or acute myeloblastic leukaemia (AML), relapsed malignancy and patients with a Broviac faced an increased risk of BSI in the multivariate analysis. Relapsed malignancy (16%) was an independent risk factor for all BSI and for Gram-positive BSI.
This study confirms relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. On a unit level, data on BSIs in this high-risk population derived from prospective surveillance are not only mandatory to decide on empiric antimicrobial treatment but also beneficial in planning and evaluating preventive bundles.
• Paediatric cancer patients face an increased risk of nosocomial bloodstream infections (BSIs). • In most cases, these BSIs are associated with the use of a long-term central venous catheter (Broviac, Port), severe and prolonged immunosuppression (e.g. neutropenia) and other chemotherapy-induced alterations of host defence mechanisms (e.g. mucositis). What is New: • This study is the first multicentre study confirming relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. • It describes the epidemiology of nosocomial BSI in paediatric cancer patients mainly outside the stem cell transplantation setting during conventional intensive therapy and argues for prospective surveillance programmes to target and evaluate preventive bundle interventions.
在一项2007年11月1日至2010年7月31日进行的关于血流感染（BSI）的前瞻性多中心研究中，来自德国的7家儿科癌症中心（PCC）和来自瑞士的1家中心纳入了770例儿科癌症患者（58%为男性；中位年龄8.3岁，四分位间距（IQR）3.8 - 14.8岁），共153,193个监测日（强化治疗期间的住院和门诊日）。所有患者中63%使用了Broviac导管，20%使用了植入式静脉输液港。142例患者（18%；95%置信区间16%至21%）经历了至少一次BSI（共179次BSI；菌血症70%，细菌性败血症27%，念珠菌血症2%）。57%的BSI发生在住院患者中，79%发生在传统化疗后。仅56%的患者在BSI发生时出现中性粒细胞减少。最终，在多变量分析中，急性淋巴细胞白血病（ALL）或急性髓细胞白血病（AML）患者、复发恶性肿瘤患者以及使用Broviac导管的患者发生BSI的风险增加。复发恶性肿瘤（16%）是所有BSI以及革兰氏阳性菌BSI的独立危险因素。
本研究证实复发恶性肿瘤是儿科癌症患者发生BSI的独立危险因素。在单位层面，来自前瞻性监测的该高危人群BSI数据不仅对于决定经验性抗菌治疗是必需的，而且在规划和评估预防性措施包方面也有益处。
• 儿科癌症患者发生医院获得性血流感染（BSI）的风险增加。• 在大多数情况下，这些BSI与长期中心静脉导管（Broviac、植入式静脉输液港）的使用、严重且长期的免疫抑制（如中性粒细胞减少）以及其他化疗引起的宿主防御机制改变（如粘膜炎）有关。新发现：• 本研究是第一项多中心研究，证实复发恶性肿瘤是儿科癌症患者发生BSI的独立危险因素。• 它描述了儿科癌症患者在传统强化治疗期间（主要在干细胞移植环境之外）医院获得性BSI的流行病学，并主张开展前瞻性监测项目以针对和评估预防性措施包干预。
