Zinner S H
Department of Medicine, Harvard Medical School, Mount Auburn Hospital, 330 Mt. Auburn Street, Cambridge, MA 02138, USA.
Int J Antimicrob Agents. 2000 Oct;16(2):97-101. doi: 10.1016/s0924-8579(00)00237-5.
As patients with malignant diseases are treated with increasingly potent agents it is likely that they will be subject to infection with an ever broadening array of microorganisms. As a result of the prompt institution of empirical antibiotics at the onset of fever in neutropenic patients, mortality has been reduced but new problems have emerged. First, there has been a shift in the type of infecting organisms responsible for bacteraemia in these patients from predominantly Gram-negative organisms to Gram-positive cocci. Secondly, perhaps as a consequence of the effectiveness of antibiotics, there is increasing concern about infections with antibiotic-resistant organisms. As an example, viridans streptococci are becoming increasingly resistant to penicillin. Thirdly, organisms previously thought to be non pathogens or 'commensals' are now being reported as agents of serious invasive infections in neutropenic patients with cancer. This review will highlight these changes and discuss 'new' pathogens in these patients.
随着恶性疾病患者接受越来越强效的药物治疗，他们感染种类日益繁多的微生物的可能性也在增加。由于在中性粒细胞减少患者发热开始时迅速给予经验性抗生素治疗，死亡率有所降低，但新问题也随之出现。首先，这些患者中导致菌血症的感染生物体类型已从主要为革兰氏阴性菌转变为革兰氏阳性球菌。其次，也许是抗生素有效性的结果，人们越来越关注对抗生素耐药生物体的感染。例如，草绿色链球菌对青霉素的耐药性越来越高。第三，以前被认为是非病原体或“共生菌”的生物体，现在被报道为癌症中性粒细胞减少患者严重侵袭性感染的病原体。本综述将突出这些变化，并讨论这些患者中的“新”病原体。
