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Blood Reviews
Article in Press, Corrected Proof - Note to users
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
BSI in haematology.pdf
(246.1 KB, 下载次数: 39)
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发表于 2008-12-4 12:40
发表于 2008-12-22 16:02