血液肿瘤患儿中心静脉导管相关血流感染的危险因素分析  

Risk factors for central venous catheter-related bloodstream infection in children with hematological malignancy

作　　者：王丹 张娜[1] 邵静波[1] 王妍捷 薛晓燕 蒋慧[1] WANG Dan;ZHANG Na;SHAO Jingbo;WANG Yanjie;XUE Xiaoyan;JIANG Hui(Department of Hematology,Shanghai Children’s Hospital,Shanghai Jiaotong University,Shanghai 200040,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院血液科,上海200040

出　　处：《中国感染与化疗杂志》2022年第1期1-7,共7页Chinese Journal of Infection and Chemotherapy

基　　金：上海市儿童医院院级课题(2020YLYM09)。

摘　　要：目的探讨中心静脉导管(CVC)相关血流感染(CRBSI)在儿童血液肿瘤患者中的相关危险因素,为降低发生率及预防反复CRBSI提供临床指导。方法收集2015年1月1日-2020年12月31日血液科行经外周静脉置入中心静脉置管(PICC)及完全植入式静脉输液港(PORT)植入的血液肿瘤患儿的基本信息,回顾性分析CRBSI病原菌种类及耐药性等数据,探索其危险因素。结果共486例置管患儿被纳入研究,其中49例患儿共发生73例次导管相关血流感染,发生率为0.6/1000导管日,CRBSI事件发生于严重粒细胞缺乏状态(ANC<0.2×10^(12)/L)和夏季多见(57.5%和46.6%);不同原发疾病(P<0.001)、带管日(P=0.034)及留置导管种类(P<0.001)差异有统计学意义。15例患儿出现反复CRBSI(≥2次),PORT植入患儿发生率明显高于PICC(P<0.001)。通过受试者工作特征(ROC)曲线分析,预测导管感染的带管日为356 d(特异度92.9%,灵敏度36.7%)。病原菌培养显示49例患者共分离出病原菌73株,以耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)为主(36株,49.3%),其次为肺炎克雷伯菌(13株,17.8%)、大肠埃希菌(4株,5.5%)、缓症链球菌(4株,5.5%)、溶血链球菌(4株,5.5%)。药敏试验未显示耐万古霉素、利奈唑胺和替考拉宁的革兰阳性细菌;产超广谱β内酰胺酶肠杆菌(ESBL-E)10株,耐碳青霉烯类肠杆菌目细菌(CRE)4株,铜绿假单胞菌对临床常用各类抗假单胞菌抗菌药物的耐药率均较低,未检测到难治性耐药铜绿假单胞菌。结论儿童CRBSI的发生与所患血液肿瘤疾病种类、严重粒细胞缺乏和季节有关;长时间留置导管导致CRBSI发生风险增加;导管置入类型是CRBSI反复发生的危险因素。带管日达356 d时对预测CRBSI发生有一定意义。儿童血液肿瘤患者CRBSI的病原菌以革兰阳性菌为主。Objective To investigate the risk factors for central venous catheter-related bloodstream infections(CRBSI)in children with hematological malignancy for reducing the incidence and recurrence of CRBSI.Methods Children with hematological malignancy who received peripherally inserted central catheter(PICC)and totally implanted vascular access ports(PORT)from January 1,2015 to December 31,2020 were enrolled.The incidence,pathogens,antimicrobial resistance,and risk factors of CRBSI were analyzed retrospectively.Results A total of 486 patients were enrolled in the study.Overall,73 cases of CRBSI occurred in 49 patients(0.6/1000 catheter days).About 57.5%of the children had severe agranulocytosis(ANC<0.2×10^(12)/L)at the time of CRBSI event,and 46.6%of CRBSI events occurred in summer.Primary disease(P<0.001),indwelling time(P=0.034),and the type of indwelling catheter(P<0.001)were associated significantly with CRBSI.Recurrent CRBSI(at least 2 episodes)was identified in 15 patients.The recurrence rate was significantly higher in the children with PORT than the children with PICC(P<0.001).The receiver operating characteristic(ROC)curve indicated that the time from indwelling catheter to CRBSI was 356 days(specificity of 92.9%and sensitivity of 36.7%).A total of 73 strains of pathogenic bacteria were isolated from the 49 patients.Coagulase-negative Staphylococcus was the predominant pathogens in CRBSI(36 strains,49.3%),followed by Klebsiella pneumoniae(13 strains,17.8%),Escherichia coli(4 strains,5.5%),Streptococcus mitis(4 strains,5.5%),and Streptococcus sanguis(4 strains,5.5%).All the gram-positive isolates were susceptible to vancomycin,linezolid,and teicoplanin.Ten strains of Enterobacterales produced extended-spectrum beta-lactamases(ESBLs)and 4 strains of Enterobacterales were resistant to carbapenems(CRE).P.aeruginosa strains were relatively sensitive to the commonly used anti-Pseudomonas antibiotics.No P.aeruginosa strain was found with difficult-to-treat resistance.Conclusions The occurrence of CRBSI in children

关 键 词：血液肿瘤 导管相关血流感染 危险因素 儿童 

分 类 号：R515.3[医药卫生—内科学]