Department of Paediatrics, University of Cape Town, Cape Town, South Africa.
Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Int J Infect Dis. 2018 Dec;77:40-47. doi: 10.1016/j.ijid.2018.09.012. Epub 2018 Sep 19.
This study was performed to investigate the epidemiology of bloodstream infection (BSI) in oncology patients at Red Cross War Memorial Children's Hospital (RCWMCH), Cape Town, with focus placed on the most common causes, complications, and antimicrobial susceptibilities in BSI.
A retrospective cross-sectional study was conducted in the Haematology-Oncology Unit of RCWMCH. All positive blood cultures from RCWMCH oncology patients obtained in 2012 to 2014 were retrieved to identify cases of BSI.
Three hundred and forty-three positive cultures were identified, for 150 BSI episodes among 89 patients; 49.1% of the culture isolates were Gram-positive bacteria, 41.6% were Gram-negative bacteria, and 9.3% were fungal. Coagulase-negative Staphylococcus and viridans group Streptococcus were the most common Gram-positive isolates. Escherichia coli and Klebsiella species were the most common Gram-negative isolates. The majority of BSI episodes occurred in patients with haematological malignancies (74%), in the presence of severe neutropenia (76.4%), and were associated with chemotherapy (88%). Complications occurred in 14% of BSI. Fungal infections had the highest prevalence of complications (21.4%). Three children died during BSI, giving a case-fatality rate of 2%.
BSI in these patients was caused mainly by Gram-positive bacteria and was associated with a low case-fatality rate. These results are consistent with worldwide experience of BSI in paediatric oncology.
本研究旨在调查开普敦红十字会纪念儿童医院（RCWMCH）肿瘤科患者血流感染（BSI）的流行病学情况，重点关注BSI 的最常见病因、并发症和抗菌药物敏感性。
在 RCWMCH 血液肿瘤科进行了一项回顾性横断面研究。检索了 2012 年至 2014 年期间从 RCWMCH 肿瘤科患者获得的所有阳性血培养物，以确定 BSI 病例。
共鉴定出 343 份阳性培养物，其中 89 名患者中有 150 例 BSI 发作；49.1%的培养分离物为革兰阳性菌，41.6%为革兰阴性菌，9.3%为真菌。凝固酶阴性葡萄球菌和草绿色链球菌是最常见的革兰阳性分离株。大肠埃希菌和克雷伯菌属是最常见的革兰阴性分离株。大多数 BSI 发作发生在血液恶性肿瘤患者（74%），伴有严重中性粒细胞减少症（76.4%），并与化疗（88%）有关。14%的 BSI 出现并发症。真菌感染的并发症发生率最高（21.4%）。3 名儿童在 BSI 期间死亡，病死率为 2%。
这些患者的 BSI 主要由革兰阳性菌引起，病死率较低。这些结果与全球儿科肿瘤患者 BSI 的经验一致。
