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Klin Padiatr 2011; 223(06): 335-340
DOI: 10.1055/s-0031-1287838
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Bloodstream Infections in Paediatric Cancer Patients. Prospective Comparative Study in 2 University Hospitals

Blutstrominfektionen bei Kindern mit Krebserkrankungen: Eine prospektive vergleichende Beobachtungsstudie in 2 Universitätskliniken
T. Krenn
1   Department of Paediatric Oncology and Haematology, University Hospital, Homburg/Saar, Germany
,
G. Fleischhack
2   Paediatric Haematology and Oncology, Children’s Hospital Medical Centre, University of Bonn, Germany
,
O. Moser
2   Paediatric Haematology and Oncology, Children’s Hospital Medical Centre, University of Bonn, Germany
,
D. Dilloo
2   Paediatric Haematology and Oncology, Children’s Hospital Medical Centre, University of Bonn, Germany
,
U. Bode
2   Paediatric Haematology and Oncology, Children’s Hospital Medical Centre, University of Bonn, Germany
,
S. Gräber
3   Institute of Medical Biometrics, Epidemiology and Medical Informatics, University Hospital, Homburg/Saar, Germany
,
R. Furtwängler
1   Department of Paediatric Oncology and Haematology, University Hospital, Homburg/Saar, Germany
,
N. Graf
1   Department of Paediatric Oncology and Haematology, University Hospital, Homburg/Saar, Germany
,
A. Simon
1   Department of Paediatric Oncology and Haematology, University Hospital, Homburg/Saar, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
19 October 2011 (online)

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Abstract

Background:

Preventive approaches (including those related to care of long term central venous catheters, CVADs) and the incidence of bloodstream infections (BSI) in 2 German university affiliated paediatric oncology units.

Patients and Methods:

Non-interventional prospective observational study using the Oncoped surveillance module.

Results:

Center A included 85 patients in 31 months and Center B 84 patients in 21 months. The populations did not differ in terms of age, gender, malignancy and disease status (first illness vs. relapse). Center A used ports (46 %) and 2 different Broviac catheters (54 %), in Center B nearly all patients with a CVAD had Broviacs (96 %). 30 BSI (24 patients) were diagnosed in Centre A and 28 BSI (22 patients) in Center B. Patients with relapsed malignancy experienced more BSI (51.4 % vs. 20.9 %; p = 0.001). Incidence rates were significantly lower in Center A (3.47 vs. 7.93 BSI/1000 CVAD days; p = 0.037). Poisson regression analysis revealed a significant lower incidence density (BSI/100 inpatient days) for all BSI in Center A (RR 0.47 CI95 0.27–0.81, p = 0.006). Overall, 52 % of all pathogens detected in blood cultures in Center A were Gram-positive (57 % in Center B) and 48 % Gram-negative (43 in Center B). One ALL patient without a CVAD died due to overwhelming sepsis caused by an ESBL-producing E. cloacae isolate.

Conclusion:

Paediatric cancer treatment centers differ substantially in regard to management of CVADs and in other preventive strategies. The most important use of local surveillance data is longitudinal internal assessment in close cooperation with microbiology and hospital hygiene experts.

Zusammenfassung

Hintergrund:

Vergleich präventiver Konzepte, einschl. des Managements von dauerhaften zentralen Venenkathetern (CVADs) und von Bakteriämien (BSI) bei pädiatrisch-onkologischen Patienten in 2 Universitätskliniken.

Patienten und Methoden:

Nicht interventionelle prospektive Beobachtungsstudie mit dem Oncoped-Surveillance-Modul.

Ergebnisse:

Zentrum A schloss in 31 Monaten 85 Patienten ein, Zentrum B 84 Patienten in 21 Monaten. Die Populationen unterschieden sich nicht signifikant in Bezug auf Alter, Geschlecht, Erkrankung und Status (Ersterkrankung vs. Rezidiv). Zentrum A nutzte ports (46 %) und 2 verschiedene Broviac-Katheter (54 %); im Zentrum B hatten nahezu alle Patienten einen Broviac (96 %). In Zentrum A wurden 30 BSI bei 24 Patienten, im Zentrum B 28 BSI bei 22 Patienten diagnostiziert. Patienten mit Rezidiv hatten mehr BSI (51,4 % vs. 20,9 %; p = 0,001). Die Inzidenzrate fìr BSI war in Zentrum A niedriger (3,47 vs. 7,93 Ereignisse/1 000 CVAD Tage; p = 0,037). In der Poisson-Regression war nur der Unterschied in der Inzidenzdichte aller BSI (BSI/100 Patiententage) signifikant (RR 0,47 CI95 0,27–0,81, p = 0,006). 52 % der Blutkulturisolate in Zentrum A waren Gram-positiv (57 % in Zentrum B) und 48 % Gram-negativ (43 % in Zentrum B). Ein ALL-Patient ohne CVAD verstarb an einer Sepsis, verursacht durch ein ESBL-bildendes E. cloacae Isolat.

Schlussfolgerung:

Zwischen pädiatrisch-onkologischen Zentren bestehen erhebliche Unterschiede in Bezug auf Strategien der Infektionsprävention. Prospektive standardisierte Surveillance-Daten dienen daher vor allem der longitudinalen Qualitätssicherung vor Ort in enger Zusammenarbeit mit Mikrobiologen und Krankenhaushygienikern.

Key words

bacteraemia - Broviac - port - children with cancer

Schlìsselwörter

Bakteriämie - Broviac - port - Kinder mit Krebserkrankung

Supplementary Material

 

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