Venditti Mario, Falcone Marco, Micozzi Alessandra, Carfagna Paolo, Taglietti Fabrizio, Serra Pietro F, Martino Pietro
Department of Clinical Medicine, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
Haematologica. 2003 Aug;88(8):923-30.
Staphylococcus aureus bacteremia (SAB) continues to be a major problem related to both community and nosocomially acquired infection. Nevertheless few data are presently available in literature about this infection in patients with hematologic malignancies.
The purpose of this retrospective study was to report further data on the clinical characteristics and outcome of patients with SAB. All episodes of SAB occurring between January 1997 and June 2001 were identified and defined by analysis of the patients' clinical records.
The nosocomial mortality rate was only 3.5% and no patient developed secondary complications. Comparison between neutropenic hematologic patients with SAB and neutropenic hematologic patients with Gram-negative bacteremia (GNB) revealed an higher mortality in the latter group (p=0.03); furthermore, severe sepsis and septic shock were more frequent in patients with GNB (p<0.001). Comparison between neutropenic patients with hematologic malignancies and non-neutropenic ones with other underlying diseases revealed significantly higher morbidity and mortality rates in the latter group. Non neutropenic patients seemed to be more susceptible to both early complications, such as severe sepsis or septic shock (p=0.002) and to later ones, such as endocarditis and metastatic abscesses (p=0.02).
Our results seem to suggest that SAB in patients with hematologic malignancies is often a low inoculum infection associated with negligible morbidity and mortality rates, especially when adequate antistaphylococcal therapy is administered promptly.
金黄色葡萄球菌菌血症（SAB）仍然是社区获得性感染和医院获得性感染的一个主要问题。然而，目前关于血液系统恶性肿瘤患者发生这种感染的文献资料很少。
这项回顾性研究的目的是报告关于SAB患者临床特征和预后的更多数据。通过分析患者的临床记录，确定并界定了1997年1月至2001年6月期间发生的所有SAB病例。
医院死亡率仅为3.5%，且无患者发生继发性并发症。对中性粒细胞减少的血液系统SAB患者与中性粒细胞减少的革兰阴性菌血症（GNB）患者进行比较，结果显示后者的死亡率更高（p=0.03）；此外，GNB患者发生严重脓毒症和感染性休克的情况更为频繁（p<0.001）。对血液系统恶性肿瘤的中性粒细胞减少患者与其他基础疾病的非中性粒细胞减少患者进行比较，结果显示后者的发病率和死亡率显著更高。非中性粒细胞减少患者似乎更容易发生早期并发症，如严重脓毒症或感染性休克（p=0.002），也更容易发生后期并发症，如心内膜炎和转移性脓肿（p=0.02）。
我们的结果似乎表明，血液系统恶性肿瘤患者的SAB通常是一种低接种量感染，其发病率和死亡率可忽略不计，尤其是在及时给予充分的抗葡萄球菌治疗时。
