Læknablaðið - 15.07.2008, Blaðsíða 19

Inga Huld
Alfreðsdóttir1
læknanemi
Valtýr
Stefánsson
Thors2
læknir
Þórólfur
Guðnason1-3
barnalæknir
Guðmundur
Jónmundsson14
barnalæknir
Jón R.
Kristinsson1’4
barnalæknir
Ólafur Gísli
Jónsson14
barnalæknir
Karl G.
Kristinsson1’5
sérfræðingur í sýklafræði
Ásgeir
Haraldsson14
barnalæknir
Lykilorð: blóðsýkingar,
börn, illkynja sjúkdómar.
’Læknadeild Háskóla
íslands
2Wilhelmína
Kinderziekenhuis,
Universiteit Ziekenhuis
Utrecht, Hollandi
3Landlæknisembættið
- Embætti
smitsjúkdómalæknis
“Barnaspítali Hringsins,
Landspítala Hringbraut
5Sýklafræðideild,
Landspítala Hringbraut
Fyrirspurnir og bréfaskipti:
Ásgeir Haraldsson,
Barnaspítala Hringsins,
Landspítala Hringbraut,
101 Reykjavík
sími: 543-1000, bréfsími:
543-3021
asgeirQlandspitali. is
FRÆÐIGREINAR
RANNSÓKNIR
Blóðsýkingar barna með æxli
og illkynja sjúkdóma 1991-2000
Ágrip
Inngangur: Árlega greinast 10-12 böm með æxli
og illkynja sjúkdóma á íslandi. Meðferð við ill-
kynja sjúkdómum eykur hættu á alvarlegum sýk-
ingum sem mikilvægt er að bregðast rétt við.
Markmið rannsóknarinnar var að meta blóðsýk-
ingar 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 böm á aldr-
inum 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 sýkla-
lyfjanotkun, aðskotahluti og afdrif.
Niðurstöður: Alls greindust 118 börn með ill-
kynja sjúkdóm eða æxli á tímabilinu. Æxli í mið-
taugakerfi (MTK) voru algengust (N=28, 23,7%),
þá hvítblæði (N=21, 17,8%) og eitlakrabbamein
(N=17, 14%). Meðalaldur bama við greiningu var
5,9 ár.
Upplýsingar úr sjúkraskrám voru fullnægjandi
fyrir 99 böm. Af þeim var 51 barn blóðræktað.
Fjöldi blóðræktana var 522. Meðalfjöldi blóðrækt-
ana var 14,8 hjá bömum 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 vom ótilgreind. Af 522
ræktunum voru 90 jákvæðar (17,2%). Algengasta
bakterían var kóagúlasa-neikvæður stafýlókokkur
(KNS) (N=53, 60%), en Staphylococcus aureus næst-
algengastur (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 daufkymingafæð (ANC <1,0 *109/
HHHí^HHHENGLISH SUMMARYHIHHHH
Alfreðsdóttir IH, Thors VS, Guðnason P, Jónmundsson G, Kristinsson JR,
Jónsson ÓG, Kristinsson KG, Haraldsson Á
Bacteremia in children with tumors or malignant diseases 1991-2000
Introduction: Ten to twelve children with tumors or malignant
diseases are diagnosed annually in lceland. 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 lceland 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 lceland
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 °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
lceland for children with malignant diseases is still effective.
Key words: bacteremia, children, malignant diseases.
Correspondence: Ásgeir Haraldsson, asgeir@iandspitaii.is
LÆKNAblaöið 2008/94 531