Nillesen, M. (Maike) (2015) De waarde van inventarisatiekweken bij langdurig neutropene patiënten in beschermende isolatie. thesis, Medicine.
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Abstract
Introduction Severe neutropenia occurs in patients with haematological malignancies undergoing intensive chemotherapy. Because of neutropenia and mucositis there is a major risk of infection. Those patients are treated in a protective environment. Cultures from throat, faeces, nose, urine and blood from the central venous catheter were collected twice weekly to detect potential pathogen micro-organisms early as possible. The question is how efficient the current policy of surveillance cultures in patients with long-term neutropenia is relating to the predictive value of systemic infection. Patients and methods Patients treated in a protective environment at Medisch Spectrum Twente from January 2012 to May 2015 were included. Those were patients with acute leukemia, multiple myeloma, recurrent Hodgkin’s lymphoma and recurrent non-Hodgkin lymphoma. The results of all surveillance cultures were explored retrospectively. Data analysis was performed using frequency tables, Cohen’s kappa, chi-square test and logistic regression analysis. Results 122 patients and 168 hospitalizations in a protective environment were analysed. Totally 911 (19,8%) of 4611 cultures were positive. A total of 57 different micro-organisms were isolated. Candida albicans (32,0%), escheria coli (20,5%) and candida glabrata (13,2%) were isolated most frequently. The same micro-organism was isolated 21 times (2,5%) in a central venous catheter culture and in another surveillance culture. Positive cultures from urine (p = 0,001) and central venous catheters (p < 0,001) were 19.4 times more likely to change the antibiotic policy than positive nasal cultures. Conclusion The current policy consisting of a protected environment, surveillance cultures, low bacteria diet and prophylactic antibiotics/selective decontamination is effective in the prevention of severe infections. The number of lethal (pulmonary) infections during severe neutropenia is low (1,6%). No micro-organisms were isolated in the surveillance cultures as cause of the lethal pneumonia. Given the low percentage (3,4%) of positive nasal cultures, those cultures can be used less.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Schaafsma, Dr. M.R. internist-hematoloog |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2391 |
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