2.50
Hdl Handle:
http://hdl.handle.net/2336/35664
Title:
Blóðsýkingar barna með æxli og illkynja sjúkdóma 1991-2000
Other Titles:
Bacteremia in children with tumors or malignant diseases 1991-2000
Authors:
Inga Huld Alfreðsdóttir; Valtýr Stefánsson Thors; Þórólfur Guðnason; Guðmundur Jónmundsson; Jón R. Kristinsson; Ólafur Gísli Jónsson; Karl G. Kristinsson; Ásgeir Haraldsson
Citation:
Læknablaðið 2008, 94(7-8):531-39
Issue Date:
1-Jul-2008
Abstract:
Introduction: Ten to twelve children with tumors or malignant diseases are diagnosed annually in Iceland. Cancer treatment can cause severe immune suppression, which makes the patients susceptible to serious infections. The aim of the current study was to evaluate sepsis in children with tumors or haematological malignancies, describe the types of bacteria cultured and their antibiotic susceptibilities, and collect information on associated risk factors. Materials and methods: This was a retrospective study on all children 0-15 years of age in Iceland who were diagnosed with a tumor or malignant disease between 1991 and 2000. Information was gathered on diagnosis, treatment, blood cultures, blood tests, antibiotic use, presence of foreign bodies (such as CVC) and survival. Results: Hundred-and-eighteen children were diagnosed with cancer or benign central nervous system (CNS) tumors in Iceland during the period 1991-2000. Central nervous system tumors were most common (N=28, 23.7%), leukemia (N=21, 17.8%) and lymphoma (N=17, 14%) were the second and third. The mean age at diagnosis was 5.9 years. Sufficient data was found in the hospital records on 99 children who were included in the study. Five hundred and twenty two blood cultures were drawn from 51 of the 99 children during the period. The mean number of blood cultures per patient was 14.8 for children with leukemia, but 2.6 for children with solid tumors. Of all blood cultures, 63.6% were from a central venous catheter or a Port-A Catheter , 5% from a peripheral site, but 30% were undisclosed. Of the 522 blood cultures, 90 grew bacteria (17.2%). Coagulase-negative staphylococci were isolated from 53 blood cultures (60%) and Staphylococcus aureus from 12 (13%). Positive cultures were regarded as a definite or possible infection in 47 blood cultures (52%), contamination in 17 (18.9% ), but uncertain in 26 (27.7%). Over 60 percent of the blood cultures (N=302) were drawn when a child was neutropenic (ANC </=1.0 *109/L). The mean length of neutropenic episodes was 9.0 days. The mean CRP level was 63.9 mg/L. The mean temperature was 38.8 degrees C. In 138 instances the child was receiving antibiotics at the time of culture (35.1%). Children with positive blood cultures had similar clinical and laboratory tests results as children with negative cultures. Conclusion: Gram-positive bacteria, especially coagulase-negative staphylococci, are much more common in children undergoing cancer therapy than Gram-negative bacteria. Results of blood tests appear to have low predictive values for blood culture results. No child died of a proven bacterial sepsis during the study period. Empiric antibiotic treatment at the Children s Hospital Iceland for children with malignant diseases is still effective. Key words: bacteremia, children, malignant diseases. Correspondence: Asgeir Haraldsson, asgeir@landspitali.is.; Inngangur: Árlega greinast 10-12 börn með æxli og illkynja sjúkdóma á Íslandi. Meðferð við illkynja sjúkdómum eykur hættu á alvarlegum sýkingum sem mikilvægt er að bregðast rétt við. Markmið rannsóknarinnar var að meta blóðsýkingar í börnum með æxli og illkynja sjúkdóma, þar með talið einstakar bakteríur og sýklalyfjanæmi þeirra. Áhættuþættir voru einnig kannaðir. Efniviður og aðferðir: Rannsóknin var aftur-skyggn og var rannsóknarþýðið öll börn á aldrinum 0-15 ára greind með illkynja sjúkdóm eða æxli á árunum 1991-2000 á Barnaspítala Hringsins. Upplýsingum var safnað um greiningu, meðferð, blóðræktanir, blóðgildi og fleira, svo sem sýklalyfjanotkun, aðskotahluti og afdrif. Niðurstöður: Alls greindust 118 börn með illkynja sjúkdóm eða æxli á tímabilinu. Æxli í miðtaugakerfi (MTK) voru algengust (N=28, 23,7%), þá hvítblæði (N=21, 17,8%) og eitlakrabbamein (N=17, 14%). Meðalaldur barna við greiningu var 5,9 ár. Upplýsingar úr sjúkraskrám voru fullnægjandi fyrir 99 börn. Af þeim var 51 barn blóðræktað. Fjöldi blóðræktana var 522. Meðalfjöldi blóðræktana var 14,8 hjá börnum með hvítblæði, en 2,6 hjá börnum með föst æxli. Blóðræktanir voru teknar úr holæðalegg eða lyfjabrunni í 63,6%, 5,4% úr útbláæð en 31% tilfella voru ótilgreind. Af 522 ræktunum voru 90 jákvæðar (17,2%). Algengasta bakterían var kóagúlasa-neikvæður stafýlókokkur (KNS) (N=53, 60%), en Staphylococcus aureus næstalgengastur (N=12, 13,3%). Jákvæð ræktun var talin tengjast líklegri eða sannaðri sýkingu í 47 tilfellum (52%), mengun í 17 (18,9%) en óvíst var með 26 ræktanir (27,7%). Barn hafði daufkyrningafæð (ANC ?1,0 *109/L) við 302 blóðræktanir (61,4%). Meðallengd daufkyrningafæðar var 9,0 dagar. C-reative protein (CRP) var að meðaltali 63,9 mg/L við blóðræktun og meðalhiti var 38,8 °C. Í 183 tilfellum var barn á sýklalyfjum við blóðræktun (35,1%). Rannsóknarniðurstöður barna með jákvæða blóðræktun voru ekki frábrugðnar öðrum. Ályktanir: Sýkingar af völdum Gram-jákvæðra baktería, sérstaklega KNS, eru nú mun algengari en Gram-neikvæðra baktería. Hluti jákvæðra ræktana getur þó verið mengun. Blóðrannsóknir virðast hafa lítið forspárgildi um niðurstöður blóðræktana. Ekkert barn lést úr blóðsýkingu af völdum baktería á tímabilinu. Reynslusýklalyfjameðferð hérlendis virðist enn árangursrík.
Description:
Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open
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Full metadata record

DC FieldValue Language
dc.contributor.authorInga Huld Alfreðsdóttir-
dc.contributor.authorValtýr Stefánsson Thors-
dc.contributor.authorÞórólfur Guðnason-
dc.contributor.authorGuðmundur Jónmundsson-
dc.contributor.authorJón R. Kristinsson-
dc.contributor.authorÓlafur Gísli Jónsson-
dc.contributor.authorKarl G. Kristinsson-
dc.contributor.authorÁsgeir Haraldsson-
dc.date.accessioned2008-08-15T15:40:08Z-
dc.date.available2008-08-15T15:40:08Z-
dc.date.issued2008-07-01-
dc.date.submitted2008-08-15-
dc.identifier.citationLæknablaðið 2008, 94(7-8):531-39en
dc.identifier.issn0023-7213-
dc.identifier.pmid18591728-
dc.identifier.urihttp://hdl.handle.net/2336/35664-
dc.descriptionNeðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Openen
dc.description.abstractIntroduction: Ten to twelve children with tumors or malignant diseases are diagnosed annually in Iceland. Cancer treatment can cause severe immune suppression, which makes the patients susceptible to serious infections. The aim of the current study was to evaluate sepsis in children with tumors or haematological malignancies, describe the types of bacteria cultured and their antibiotic susceptibilities, and collect information on associated risk factors. Materials and methods: This was a retrospective study on all children 0-15 years of age in Iceland who were diagnosed with a tumor or malignant disease between 1991 and 2000. Information was gathered on diagnosis, treatment, blood cultures, blood tests, antibiotic use, presence of foreign bodies (such as CVC) and survival. Results: Hundred-and-eighteen children were diagnosed with cancer or benign central nervous system (CNS) tumors in Iceland during the period 1991-2000. Central nervous system tumors were most common (N=28, 23.7%), leukemia (N=21, 17.8%) and lymphoma (N=17, 14%) were the second and third. The mean age at diagnosis was 5.9 years. Sufficient data was found in the hospital records on 99 children who were included in the study. Five hundred and twenty two blood cultures were drawn from 51 of the 99 children during the period. The mean number of blood cultures per patient was 14.8 for children with leukemia, but 2.6 for children with solid tumors. Of all blood cultures, 63.6% were from a central venous catheter or a Port-A Catheter , 5% from a peripheral site, but 30% were undisclosed. Of the 522 blood cultures, 90 grew bacteria (17.2%). Coagulase-negative staphylococci were isolated from 53 blood cultures (60%) and Staphylococcus aureus from 12 (13%). Positive cultures were regarded as a definite or possible infection in 47 blood cultures (52%), contamination in 17 (18.9% ), but uncertain in 26 (27.7%). Over 60 percent of the blood cultures (N=302) were drawn when a child was neutropenic (ANC </=1.0 *109/L). The mean length of neutropenic episodes was 9.0 days. The mean CRP level was 63.9 mg/L. The mean temperature was 38.8 degrees C. In 138 instances the child was receiving antibiotics at the time of culture (35.1%). Children with positive blood cultures had similar clinical and laboratory tests results as children with negative cultures. Conclusion: Gram-positive bacteria, especially coagulase-negative staphylococci, are much more common in children undergoing cancer therapy than Gram-negative bacteria. Results of blood tests appear to have low predictive values for blood culture results. No child died of a proven bacterial sepsis during the study period. Empiric antibiotic treatment at the Children s Hospital Iceland for children with malignant diseases is still effective. Key words: bacteremia, children, malignant diseases. Correspondence: Asgeir Haraldsson, asgeir@landspitali.is.en
dc.description.abstractInngangur: Árlega greinast 10-12 börn með æxli og illkynja sjúkdóma á Íslandi. Meðferð við illkynja sjúkdómum eykur hættu á alvarlegum sýkingum sem mikilvægt er að bregðast rétt við. Markmið rannsóknarinnar var að meta blóðsýkingar í börnum með æxli og illkynja sjúkdóma, þar með talið einstakar bakteríur og sýklalyfjanæmi þeirra. Áhættuþættir voru einnig kannaðir. Efniviður og aðferðir: Rannsóknin var aftur-skyggn og var rannsóknarþýðið öll börn á aldrinum 0-15 ára greind með illkynja sjúkdóm eða æxli á árunum 1991-2000 á Barnaspítala Hringsins. Upplýsingum var safnað um greiningu, meðferð, blóðræktanir, blóðgildi og fleira, svo sem sýklalyfjanotkun, aðskotahluti og afdrif. Niðurstöður: Alls greindust 118 börn með illkynja sjúkdóm eða æxli á tímabilinu. Æxli í miðtaugakerfi (MTK) voru algengust (N=28, 23,7%), þá hvítblæði (N=21, 17,8%) og eitlakrabbamein (N=17, 14%). Meðalaldur barna við greiningu var 5,9 ár. Upplýsingar úr sjúkraskrám voru fullnægjandi fyrir 99 börn. Af þeim var 51 barn blóðræktað. Fjöldi blóðræktana var 522. Meðalfjöldi blóðræktana var 14,8 hjá börnum með hvítblæði, en 2,6 hjá börnum með föst æxli. Blóðræktanir voru teknar úr holæðalegg eða lyfjabrunni í 63,6%, 5,4% úr útbláæð en 31% tilfella voru ótilgreind. Af 522 ræktunum voru 90 jákvæðar (17,2%). Algengasta bakterían var kóagúlasa-neikvæður stafýlókokkur (KNS) (N=53, 60%), en Staphylococcus aureus næstalgengastur (N=12, 13,3%). Jákvæð ræktun var talin tengjast líklegri eða sannaðri sýkingu í 47 tilfellum (52%), mengun í 17 (18,9%) en óvíst var með 26 ræktanir (27,7%). Barn hafði daufkyrningafæð (ANC ?1,0 *109/L) við 302 blóðræktanir (61,4%). Meðallengd daufkyrningafæðar var 9,0 dagar. C-reative protein (CRP) var að meðaltali 63,9 mg/L við blóðræktun og meðalhiti var 38,8 °C. Í 183 tilfellum var barn á sýklalyfjum við blóðræktun (35,1%). Rannsóknarniðurstöður barna með jákvæða blóðræktun voru ekki frábrugðnar öðrum. Ályktanir: Sýkingar af völdum Gram-jákvæðra baktería, sérstaklega KNS, eru nú mun algengari en Gram-neikvæðra baktería. Hluti jákvæðra ræktana getur þó verið mengun. Blóðrannsóknir virðast hafa lítið forspárgildi um niðurstöður blóðræktana. Ekkert barn lést úr blóðsýkingu af völdum baktería á tímabilinu. Reynslusýklalyfjameðferð hérlendis virðist enn árangursrík.is
dc.languageICE-
dc.language.isoisen
dc.publisherLæknafélag Íslands, Læknafélag Reykjavíkuren
dc.relation.urlhttp://www.laeknabladid.isen
dc.subjectBlóðsýkingaren
dc.subjectBörnen
dc.subject.meshBacteremiaen
dc.subject.meshChilden
dc.subject.meshGram-Negative Bacteriaen
dc.subject.meshNeoplasmsen
dc.titleBlóðsýkingar barna með æxli og illkynja sjúkdóma 1991-2000is
dc.title.alternativeBacteremia in children with tumors or malignant diseases 1991-2000en
dc.typeArticleen
dc.identifier.journalLæknablaðiðen

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