Clinical Features of Bloodstream Infection in Children with Haematological Malignancies

摘要

Purpose: Sepsis and bacteraemia are both referred to as bloodstream infection (BSI). It contributed majorly to the mortality of the children with blood cancer. In order to reveal the clinical features of BSI and improve its outcome, we performed the investigation among the inpatients in haematology/oncology department. Methods: Neutropenia was defined as an absolute neutrophil count (ANC) in peripheral blood of 9/L. Microbiologically documented infection (MDI) was defined when causative pathogen was isolated from blood. Drug susceptibility test was performed using the VITEK-60 Auto Microbic System and Kirby-Baue disk diffusion method. Relative cytokines in the sera were detected through flow cytometry (FCM). All of the data were analysed with STATA software (version 9.0). Results: The incidence of BSI was 10.73% (161/1500), the rate of MDI for BSI was 43.48% (70/161). There was no statistical significance between non-MDI and MDI groups on the clinical characteristics. Total 79 strains were detected from 70 blood samples. Gram-positive bacteria, gram-negative bacteria and fungi accounted for 55.70% (44/79), 43.04% (34/79) and 1.27% (1/79), respectively. The most common pathogens were Staphylococcus epidermidis (20.25%), Escherichia coli (15.19%) and Klebsiella pneumoniae (15.19%). Staphylococcus showed no/low resistance to linezolid, vancomycin and furantoin. Gram-negative bacteria showed no/low resistance to cefoxitin, imipenem, piperacillin/tazobactam and amikacin. The mortality of BSI was 3.1% (5/161). Conclusions: BSI had no specific signs and symptoms clinically, and gram-positive bacteria were the dominant pathogens. Antibiotics selection according to the susceptibility test was superior to the empirical treatment. Improved prevention, early detection, and advanced therapeutic strategies might decrease the incidence of the BSI and improve its treatment outcome.