Agger Kirstine E, Schrøder Henrik, Rosthøj Steen, Carlsen Niels Torp, Schmiegelow Kjeld
Arhus Universitetshospital, Skejby Sygehus, børneonkologisk afdeling, DK-8200 Arhus N.
Ugeskr Laeger. 2002 Jan 21;164(4):488-92.
Children with acute lymphoblastic leukaemia (ALL) are treated with intensive chemotherapy, which results in profound immunosuppression. Treatment with trimethoprim/sulphamethoxazole (TMP-SMX) is therefore used in some departments as prophylaxis against infections with both bacteria and Pneumocystis carinii. The use of TMP/SMX for prophylaxis during the induction therapy is not uniform in the four departments of paediatric oncology in Denmark. This gave us the opportunity to describe the effect of TMP/SMX on bacterial infections in children with ALL during the induction therapy.
Between 1 January 1992 and 31 December 1997, 210 children were diagnosed with ALL in Denmark. From a retrospective review of the medical charts, the number of children with fever (> 38 degrees C), the number of febrile days, days of antibiotic treatment, and the number of positive blood cultures were registered for each febrile episode.
One hundred and fourteen children received TMP/SMX prophylaxis (10-30 mg/SMX/kg/day) and 76 did not. Children who received TMP/SMX prophylaxis had significantly fewer episodes of fever (66/114 (58%) vs. 60/76 (79%), p < 0.01) and significantly fewer children who received the prophylaxis had positive blood cultures before the start of antibiotic treatment compared with children who did not receive prophylaxis (23/114 (20%) vs 37/76 (49%), p < 0.001)). Nineteen different species were isolated from the blood stream before the start of antibiotic treatment. In the non-prophylaxis group there were a preponderance of isolates with Staph. aureus, Str. pneumoniae, E. coli, and P. aeruginosa. There was no difference in the mortality between the two groups (p = 0.44). There were no cases of P. carinii pneumonia in the period of induction therapy.
TMP/SMX prophylaxis during induction therapy for childhood ALL seems to reduce the risk of bacteraemias and febrile illness.
急性淋巴细胞白血病（ALL）患儿接受强化化疗，这会导致严重的免疫抑制。因此，一些科室使用甲氧苄啶/磺胺甲恶唑（TMP-SMX）进行治疗，以预防细菌和卡氏肺孢子虫感染。在丹麦的四个儿科肿瘤科室中，诱导治疗期间使用TMP/SMX进行预防的情况并不统一。这使我们有机会描述TMP/SMX对ALL患儿诱导治疗期间细菌感染的影响。
1992年1月1日至1997年12月31日期间，丹麦有210名儿童被诊断为ALL。通过对病历的回顾性研究，记录了每个发热发作期发热（>38摄氏度）儿童的数量、发热天数、抗生素治疗天数以及血培养阳性的数量。
114名儿童接受了TMP/SMX预防治疗（10-30毫克/磺胺甲恶唑/千克/天），76名儿童未接受。接受TMP/SMX预防治疗的儿童发热发作次数明显较少（66/114（58%）对60/76（79%），p<0.01），与未接受预防治疗的儿童相比，接受预防治疗的儿童在开始抗生素治疗前血培养阳性的儿童明显较少（23/114（20%）对37/76（49%），p<0.001）。在开始抗生素治疗前，从血流中分离出19种不同的菌种。在未预防治疗组中，以金黄色葡萄球菌、肺炎链球菌、大肠杆菌和铜绿假单胞菌的分离株居多。两组之间的死亡率没有差异（p=0.44）。诱导治疗期间没有卡氏肺孢子虫肺炎病例。
儿童ALL诱导治疗期间使用TMP/SMX预防似乎可降低菌血症和发热性疾病的风险。
Zotero 插件