血液病患者的血流感染：风险和预防新挑战

Blood Reviews

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Copyright © 2008 Elsevier Ltd All rights reserved.

REVIEW

Bloodstream infections in haematology: Risks and new challenges for prevention

血液病患者的血流感染：风险和预防新挑战

Leon J. Worth, a, b,  and Monica A. Slavina, b


aDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, St Andrew’s Place, East Melbourne, Victoria 3002, Australia


bCentre for Clinical Research Excellence in Infectious Diseases, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia



Available online 28 November 2008.


Summary

Bloodstream infections are an important cause of morbidity and mortality in the haematology population, and may contribute to delayed administration of chemotherapy, increased length of hospitalisation, and increased healthcare expenditure. For gram-positive, gram-negative, anaerobic and fungal infections, specific risk factors are recognised. Unique host and environmental factors contributing to pathogenesis are acknowledged in this population. Trends in spectrum and antimicrobial susceptibility of pathogens are examined, and potential contributing factors are discussed. These include the widespread use of empiric antimicrobial therapy, increasingly intensive chemotherapeutic regimens, frequent use of central venous catheters, and local infection control practices. In addition, the risks and benefits of prophylaxis, and spectrum of endemic flora are identified as relevant factors within individual centres. Finally, challenges are presented regarding prevention, early detection, surveillance and prophylaxis. To reduce the rate and impact of bloodstream infections multifaceted and customised strategies are required within individual haematology units.


Keywords: Bloodstream infection; Bacteraemia; Fungaemia; Haematology; Risk; Prevention; Central venous catheter


Article Outline

Introduction

Risk stratification in haematology

Gram-positive bloodstream infections

Gram-negative bloodstream infections

Anaerobic bloodstream infections

Fungal bloodstream infections

Prognostic markers in haematology patients with bloodstream infections

(a) Organism factors

(b) Host factors – general

(c) Host factors – specific clinical presentations

Recent trends and changes in spectrum

New challenges

(a) Prevention

(b) Early detection

(c) Prophylaxis

(d) Infection control and screening measures

(e) Treatment

(f) Antimicrobial stewardship

(g) Adjuvant therapy

The future

Conflict of interest statement

References