Maschmeyer G, Braveny I
Charite University Hospital, Robert Roessle Cancer Center, Berlin, Germany.
Eur J Clin Microbiol Infect Dis. 2000 Dec;19(12):915-25. doi: 10.1007/s100960000410.
In an attempt to determine the actual relevance of Pseudomonas aeruginosa as a target of empiric antimicrobial first-line therapy in febrile cancer patients, 44 reports of clinical trials on antimicrobial treatment regimens and 53 reports on the epidemiology of microbiologically documented infections in cancer patients were reviewed. The incidence of infections due to Pseudomonas aeruginosa was 1-2.5% among all patients presenting with first fever during neutropenia, and 5-12% among patients with microbiologically documented infections. The proportion of Pseudomonas aeruginosa infections among cases of gram-negative bacteremia has not generally declined during the past 2 decades. There were marked local and regional differences regarding the incidence of documented Pseudomonas aeruginosa infections. No clear differences between neutropenic and non-neutropenic cancer patients, between patients with solid tumors and those with hematologic malignancies, or between inpatients and outpatients presenting with fever and neutropenia were detected with respect to the likelihood of Pseudomonas aeruginosa involvement. The mortality rate in patients with Pseudomonas aeruginosa bacteremia, particularly with polymicrobial bacteremia or bacteremic pneumonia with Pseudomonas aeruginosa involvement, is considerably high. The beneficial impact on mortality of an empiric antimicrobial treatment regimen with high antipseudomonal activity has not yet been demonstrated unequivocally. Additional factors such as the quality of intensive care management, effective second-line antimicrobial regimens, local resistance patterns, and patient-related cofactors are very likely to influence the outcome of Pseudomonas aeruginosa infections in cancer patients.
为了确定铜绿假单胞菌作为发热癌症患者经验性抗菌一线治疗靶点的实际相关性，我们回顾了44篇关于抗菌治疗方案的临床试验报告和53篇关于癌症患者微生物学确诊感染流行病学的报告。在所有中性粒细胞减少期间首次发热的患者中，铜绿假单胞菌引起的感染发生率为1%-2.5%，在微生物学确诊感染的患者中为5%-12%。在过去20年中，革兰阴性菌血症病例中铜绿假单胞菌感染的比例总体上没有下降。关于确诊的铜绿假单胞菌感染发生率存在明显的局部和区域差异。在铜绿假单胞菌感染的可能性方面，未检测到中性粒细胞减少和非中性粒细胞减少的癌症患者之间、实体瘤患者和血液系统恶性肿瘤患者之间、或发热伴中性粒细胞减少的住院患者和门诊患者之间存在明显差异。铜绿假单胞菌血症患者的死亡率相当高，尤其是伴有多微生物菌血症或伴有铜绿假单胞菌感染的菌血症性肺炎患者。具有高抗铜绿假单胞菌活性的经验性抗菌治疗方案对死亡率的有益影响尚未得到明确证实。其他因素，如重症监护管理质量、有效的二线抗菌方案、局部耐药模式以及与患者相关的辅助因素，很可能会影响癌症患者铜绿假单胞菌感染的结局。
