Funada H, Yoneyama H, Machi T, Matsuda T
Protected Environment Unit, Kanazawa University, Japan.
Kansenshogaku Zasshi. 1992 Oct;66(10):1436-43. doi: 10.11150/kansenshogakuzasshi1970.66.1436.
During the 20-year period, 1972-1991, 27 episodes of Staphylococcus aureus bacteremia, including 10 with methicillin-resistant strains (MRSA), were documented in 26 patients with hematologic disorders, mainly acute leukemia and malignant lymphoma, representing 6% of all 433 episodes of bacteremia in a hematology unit. MRSA replaced methicillin-sensitive strains (MSSA) in the last four years. The skin and upper respiratory tract were the two most common primary foci. Most episodes occurred during neutropenia. Pharyngeal colonization often preceded the development of bacteremia. Antibiotic therapy predisposed to MRSA acquisition during hospitalization, whereas MSSA was mostly detected in admission cultures. Among 22 patients with monomicrobial bacteremia, 19 (86%) survived longer than one week, including all four with MRSA bacteremia who received vancomycin. The survival rate did not differ materially between MRSA and MSSA bacteremias. Secondary foci, chiefly located in the lung, were found in 30% of all patients with S. aureus bacteremia. Prolonged antibiotic therapy, therefore, seems warranted in patients with evident metastatic lesions, although abbreviated therapy is proposed in neutropenic cancer patients.
在1972年至1991年的20年期间，26例血液系统疾病患者记录了27次金黄色葡萄球菌菌血症发作，其中包括10例耐甲氧西林菌株（MRSA），主要为急性白血病和恶性淋巴瘤，占血液科所有433次菌血症发作的6%。在过去四年中，MRSA取代了甲氧西林敏感菌株（MSSA）。皮肤和上呼吸道是两个最常见的原发部位。大多数发作发生在中性粒细胞减少期间。咽部定植常常先于菌血症的发生。抗生素治疗易导致住院期间获得MRSA，而MSSA大多在入院培养时检测到。在22例单一微生物菌血症患者中，19例（86%）存活超过一周，包括所有4例接受万古霉素治疗的MRSA菌血症患者。MRSA菌血症和MSSA菌血症的存活率没有实质性差异。在所有金黄色葡萄球菌菌血症患者中，30%发现了主要位于肺部的继发部位。因此，对于有明显转移性病变的患者，似乎有必要进行延长抗生素治疗，尽管有人建议对中性粒细胞减少的癌症患者进行缩短疗程的治疗。
