Persson L, Vikerfors T, Sjöberg L, Engervall P, Tidefelt U
Department of Infectious Diseases, Orebro Medical Centre Hospital, Sweden.
Scand J Infect Dis. 2000;32(6):615-21. doi: 10.1080/003655400459513.
The aetiology, clinical characteristics and outcome of bacteraemia in patients with acute myeloid leukaemia were studied. All positive blood cultures collected at a haematological ward during 2 7-y periods were evaluated. Altogether, 274 episodes of bacteraemia in 152 patients were recorded, 80 episodes during 1980-86 and 194 during 1990-96. During the 2 periods, trimethoprim-sulfamethoxazol in combination with amikacin was the first-line empirical therapy in patients with neutropaenia and fever. In 1990, antimicrobial prophylaxis with ciprofloxacin and fluconazole was introduced. The incidence of bacteraemia due to viridans streptococci or coagulase-negative staphylococci increased from the first period to the second, whereas the incidence of Enterobacteriaceae decreased. In granulocytopaenic patients during 1990-96, viridans streptococci accounted for 21% of the isolates and in patients treated prophylactically with fluoroquinolone, viridans streptococci accounted for 31%. All viridans streptococci were sensitive to penicillin. At the time of the positive blood cultures, the patients of the second period were granulocytopaenic in 83% of the episodes. The mortality related to septicaemia during the later period was 13% and only 1 of 33 (3%) of the patients with viridans streptococci died. Eight patients (9%) died in relation to septicaemia following curative antileukaemic therapy.
对急性髓系白血病患者菌血症的病因、临床特征及转归进行了研究。对在一个血液科病房2个7年期间采集的所有阳性血培养标本进行了评估。共记录了152例患者的274次菌血症发作，1980 - 1986年期间有80次，1990 - 1996年期间有194次。在这两个时期，甲氧苄啶 - 磺胺甲恶唑联合阿米卡星是中性粒细胞减少和发热患者的一线经验性治疗药物。1990年引入了环丙沙星和氟康唑进行抗菌预防。草绿色链球菌或凝固酶阴性葡萄球菌所致菌血症的发生率从第一个时期到第二个时期有所增加，而肠杆菌科细菌的发生率则下降。在1990 - 1996年粒细胞缺乏的患者中，草绿色链球菌占分离菌的21%，在接受氟喹诺酮预防性治疗的患者中，草绿色链球菌占31%。所有草绿色链球菌对青霉素敏感。在血培养阳性时，第二个时期的患者在83%的发作中存在粒细胞缺乏。后期与败血症相关的死亡率为13%，草绿色链球菌感染的33例患者中仅1例（3%）死亡。8例患者（9%）在根治性抗白血病治疗后死于败血症相关疾病。
