Elishoov H, Or R, Strauss N, Engelhard D
Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel.
Medicine (Baltimore). 1998 Mar;77(2):83-101. doi: 10.1097/00005792-199803000-00002.
In this 5-year prospective study of 242 bone marrow transplantation (BMT) recipients from whom daily blood cultures via the indwelling Broviac/Hickman catheter were obtained, there was a median of 35 catheter-days during hospitalization, mean of 40 days, and total of 9,667 catheter-days which were divided almost equally between neutropenic (4,771) and non-neutropenic (4,896) days. One hundred twenty (50%) patients had a total of 161 episodes of nosocomial bacterial or candidal infections. Overall, 81 (33%) patients experienced 100 episodes of catheter-related infections and 90 (37%) patients experienced 112 episodes of septicemia, including 51 episodes of catheter-related septicemia. There was an incidence of 11.59 septicemia episodes, including 5.28 catheter-related septicemia episodes, 2.48 colonization only (without subsequent septicemia), and 2.59 exit site infections only, per 1,000 catheter-days. Over a period of a total of 6,593 afebrile days, 34 (14%) patients developed 40 episodes of colonization, a rate of 6.07 per 1,000 afebrile days, of which 16 developed into septicemia. Twenty-five patients had 1 episode each of exit site infection without bacteremia. There were 10 (4%) septicemia-related deaths, 4 of which were catheter-related; 50% of all deaths involved Pseudomonas aeruginosa. The mortality due to catheter-related septicemic episodes was not greater than that of the non-catheter-related episodes. Neutropenia was found to be a significant risk factor in our study: 76% of the septicemia episodes (85/112) and 65% of the catheter-related infectious episodes (65/100) occurred during neutropenia. There was a higher incidence of septicemic episodes during neutropenia than during non-neutropenic periods, 17.82 versus 5.51 per 1,000 days (p < 0.0001), and a higher rate of catheter-related infections during the neutropenic period, 13.62 versus 7.15 during non-neutropenic days per 1,000 days (0.001). Fourteen of 16 colonization episodes developed into septicemia during neutropenia versus 2/24 during non-neutropenic periods, a rate of 5.47 versus 0.47 per 1,000 afebrile days, respectively (p < 0.0001), and 9/10 deaths occurred during neutropenia.
在这项针对242例接受骨髓移植（BMT）患者的5年前瞻性研究中，通过留置的Broviac/Hickman导管每日进行血培养。住院期间导管使用天数中位数为35天，平均为40天，总计9667个导管日，其中中性粒细胞减少期（4771天）和非中性粒细胞减少期（4896天）几乎各占一半。120例（50%）患者共发生161次医院获得性细菌或念珠菌感染。总体而言，81例（33%）患者发生100次导管相关感染，90例（37%）患者发生112次败血症，其中包括51次导管相关败血症。每1000个导管日败血症发生率为11.59次，其中导管相关败血症发生率为5.28次，仅定植（无后续败血症）发生率为2.48次，仅出口部位感染发生率为2.59次。在总共6593个无发热日期间，34例（14%）患者发生40次定植，发生率为每1000个无发热日6.07次，其中16例发展为败血症。25例患者各发生1次无菌血症的出口部位感染。有10例（4%）与败血症相关的死亡，其中4例与导管相关；所有死亡病例中有50%涉及铜绿假单胞菌。导管相关败血症发作导致的死亡率不高于非导管相关发作。在我们的研究中，中性粒细胞减少被发现是一个重要的危险因素：76%的败血症发作（85/112）和65%的导管相关感染发作（65/100）发生在中性粒细胞减少期。中性粒细胞减少期败血症发作的发生率高于非中性粒细胞减少期，分别为每1000天17.82次和5.51次（p<0.0001），中性粒细胞减少期导管相关感染的发生率更高，每1000天中性粒细胞减少期为13.62次，非中性粒细胞减少期为7.15次（p = 0.
