Zakhour Ramia, Hachem Ray, Alawami Hussain M, Jiang Ying, Michael Majd, Chaftari Anne-Marie, Raad Issam
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Pediatr Blood Cancer. 2017 Oct;64(10). doi: 10.1002/pbc.26537. Epub 2017 Apr 14.
Central venous catheters (CVCs) are essential to treatment of children with cancer. There are no studies comparing catheter-related bloodstream infections (CRBSIs) in pediatric cancer patients to those in adults, although current guidelines for management of CRBSI do not give separate guidelines for the pediatric population. In this study, we compared CRBSIs in both the pediatric and adult cancer population.
We retrospectively reviewed the electronic medical records of 92 pediatric and 156 adult patients with CRBSI cared for at MD Anderson Cancer Center between September 2005 and March 2014.
We evaluated 248 patients with CRBSI. There was a significant difference in etiology of CRBSI between pediatric and adult patients (P = 0.002), with the former having less Gram-negative organisms (27 vs. 46%) and more polymicrobial infections (10 vs. 1%, P = 0.003). Pediatric patients had less hematologic malignancies (58 vs. 74%) and less neutropenia at presentation (40 vs. 54%) when compared with adult patients. Peripheral blood cultures were available in only 43% of pediatric cases. CVC was removed in 64% of pediatric cases versus 88% of adult cases (P < 0.0001).
We found higher rates of Gram-negative organisms in adults and higher rates of polymicrobial in children. Because of the low rates of peripheral blood cultures and the low rates of CVC removal, CRBSI diagnosis could be challenging in pediatrics. A modified CRBSI definition relying more on clinical criteria may be warranted.
中心静脉导管（CVC）对于癌症患儿的治疗至关重要。尽管目前导管相关血流感染（CRBSI）的管理指南未针对儿科人群给出单独的指南，但尚无研究比较儿科癌症患者与成人患者的CRBSI情况。在本研究中，我们比较了儿科和成人癌症人群的CRBSI情况。
我们回顾性分析了2005年9月至2014年3月在MD安德森癌症中心接受治疗的92例儿科CRBSI患者和156例成人CRBSI患者的电子病历。
我们评估了248例CRBSI患者。儿科和成人患者CRBSI的病因存在显著差异（P = 0.002），前者革兰氏阴性菌较少（27%对46%），多微生物感染较多（10%对1%，P = 0.003）。与成人患者相比，儿科患者血液系统恶性肿瘤较少（58%对74%），就诊时中性粒细胞减少较少（40%对54%）。仅43%的儿科病例可获得外周血培养结果。64%的儿科病例拔除了CVC，而成人病例为88%（P < 0.0001）。
我们发现成人革兰氏阴性菌感染率较高，儿童多微生物感染率较高。由于外周血培养率低和CVC拔除率低，CRBSI在儿科的诊断可能具有挑战性。可能需要一个更多依赖临床标准的改良CRBSI定义。
