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

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CRBS...

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

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<0.2×10¹²/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 was related to the type of hematological malignancy,severe agranulocytosis,and season.Long-term indwelling catheter increases the risk of CRBSI.The type of indwelling catheter is a risk factor for recurrent CRBSI.Longer indwelling central venous catheter(>356 days)can predict the occurrence of CRBSI.Gram-positive bacteria are the mainly pathogen of CRBSI in children with hematological malignancy.