Anatoliotaki M, Valatas V, Mantadakis E, Apostolakou H, Mavroudis D, Georgoulias V, Rolston K V, Kontoyiannis D P, Galanakis E, Samonis G
University General Hospital of Heraklion, Crete, Greece.
Infection. 2004 Apr;32(2):65-71. doi: 10.1007/s15010-004-3049-5.
Although patients with malignant diseases are at increased risk for bloodstream infections (BSIs), limited data are available for those with solid tumors.
The etiology, clinical features and outcome of BSIs were retrospectively studied in patients with solid tumors treated at the Department of Medical Oncology at the University Hospital of Heraklion, Greece, from November 1995 through June 2000.
A total of 157 episodes of BSIs was identified among 137 patients over the study period. The majority of the episodes (128; 82%) occurred in non-neutropenic patients. 80 of 157 (51%) of the episodes were healthcare-associated, 35% (55 of 157) were nosocomial and 14% (22 of 157) were community acquired. A single pathogen was isolated in 86% of the episodes. A total of 184 pathogens was isolated (51% gram-negative rods, 44% gram-positive cocci, 3% anaerobes and 3% fungi), while the portal of entry was identified in 104 of 157 (66%) of the episodes. The site of the primary tumor or the metastases were the source of BSI in 39 of 104 (37.5%) of the episodes with an identified source. The overall infectious mortality was 20% and was significantly higher when the initial empirical antibiotic therapy was inappropriate (39%; p < 0.001) and in the presence of shock (63%; p < 0.001).
BSIs in patients with solid tumors are frequently healthcare associated and in a large percentage the portal of entry can be identified. Neutropenia is not as common as in patients with hematologic malignancies. Inappropriate initial empirical antibiotic therapy and shock are clinical factors associated with worse outcomes.
尽管恶性疾病患者发生血流感染（BSIs）的风险增加，但关于实体瘤患者的相关数据有限。
对1995年11月至2000年6月在希腊伊拉克利翁大学医院医学肿瘤学系接受治疗的实体瘤患者的BSIs病因、临床特征及转归进行回顾性研究。
在研究期间，137例患者中共发现157次BSIs发作。大多数发作（128次；82%）发生在非中性粒细胞减少患者中。157次发作中有80次（51%）与医疗保健相关，35%（157次中的55次）为医院内感染，14%（157次中的22次）为社区获得性感染。86%的发作中分离出单一病原体。共分离出184种病原体（51%为革兰氏阴性杆菌，44%为革兰氏阳性球菌，3%为厌氧菌，3%为真菌），157次发作中有104次（66%）确定了感染途径。在104次确定了感染源的发作中，39次（37.5%）的原发性肿瘤或转移灶部位是BSIs的来源。总体感染死亡率为20%，当初始经验性抗生素治疗不恰当（39%；p<0.001）以及存在休克时（63%；p<0.001），死亡率显著更高。
实体瘤患者的BSIs常与医疗保健相关，且在很大比例的病例中可确定感染途径。中性粒细胞减少不像血液系统恶性肿瘤患者那样常见。初始经验性抗生素治疗不恰当和休克是与较差转归相关的临床因素。
