ABSTRACT
Objective To investigate the incidence of central line-associated bloodstream infection (CLABSI) in patients with hematopoietic stem cell transplantation (HSCT), explore risk factors for the occurrence of CLABSI.Methods Basic information of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who underwent HSCT in a hematology department from November 1, 2016 to October 31, 2017 was collected, incidences of original CLABSI (OCLABSI) and modified CLABSI (MCLABSI) were calculated, related risk factors were analyzed by multivariate Cox regression.Results A total of 218 patients with AML and MDS who underwent HSCT were enrolled, 19 of whom had OCLABSI and 10 had MCLABSI.Twenty-one strains of pathogens were isolated from 19 patients with OCLABSI, including 9 gram-positive bacteria, 11 gram-negative bacteria, 1 fungus;9 strains were multidrug-resistant organisms.The main risk factors for OCLABSI included the female (HR=0.088;95％CI:0.017-0.440;P=0.003), age (HR=1.560;95％CI:1.066-2.530;P=0.034), bone marrow cell transplantation only (HR=4.408;95％CI:1.860-22.593;P=0.043), ATG/CSA/MMF/MTXG for preventing graft-versus-host disease (GVHD) (HR=0.101;95％CI:0.015-0.686;P=0.019), and MTX for preventing GVHD (HR=0.097;95％CI:0.011-0.816;P=0.032).Conclusion Definition of MCLABSI can provide more accurate monitoring on deep central venous catheter-related bloodstream infection.Incidence of CLABSI in HSCT patients can be reduced by early detection of high-risk population according to high-risk factors, strict adherence to the prevention and control measures of bloodstream infection, and implementation of immune recombination after enhanced transplantation.
ABSTRACT
Objective To investigate current status of hemodialysis,and qualified status of dialysis water and dia-lysate in a city. Methods Status of hemodialysis in 36 medical institutions in a city which conducted blood purifica-tion programme was surveyed,dialysis water and dialysate were collected to perform microbial detection(including conventional and low temperature culture methods)and on-site ATP detection.Results 13.89% of equipments for water treatment were used less than 1 year,5.56% were used for more than 10 years. 77.78% of medical institu-tions didn't replace sand filtration which had been used for more than 1 year,the replacement time of 72.22% of fil-ter core was less than 3 months,2.78% of reverse water supply pipeline was used for more than 10 years.77.78%of medical institutions used finished A solution,72.22% used finished B solution,22.22% used centrally provided A solution,19.44% used centrally provided B solution,and 8.34% used self-made B solution. Routine microbial detection in 36 medical institutions were qualified,but 80.56% of detection results were"0" value for long period;ATP detection of on-site collected dialysis water and dialysate were all qualified. One specimen for microbial detec-tion under normal temperature exceeded the standard,2 reached the intervention value;4 specimens for microbial detection under low temperature exceeded the standard,6 reached the intervention value;qualified rates of 3 kinds of detection methods among different levels of medical institutions weren't significantly different(all P>0.05).Con-clusion The overall quality of hemodialysis water and dialysate in this city is good,the majority of medical institutions pay attention to the routine maintenance of water treatment equipment,detect the quality of hemodialysis water and dialysate regularly,but microbial detection technique needs to be improved,causes for abnormal results or intervention value of rou-tine detection needs to be analyzed and improved continuously.