Sahagún Pareja J, Castillo F J, Andrés R, Capilla S, Mayordomo J I, Pitart C, Tres A
Servicios de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza.
Rev Esp Quimioter. 2005 Mar;18(1):32-8.
The evolution of the flora and its resistance to different antimicrobials in neutropenic patients submitted to high-dose chemotherapy with autologous blood stem-cell transplantation, and the relation of these findings to the etiology of the infections the patients developed was studied in order to evaluate the suitability of the chemoprophylaxis and the empirical antibiotic therapy used. Forty-one patients were analyzed in a period of 28 months. The chemoprophylaxis used was levofloxacin, fluconazole and acyclovir. The empirical sequential treatment was an initial administration of cefepime, followed by teicoplanin and amikacin. Cultures were done of nasal and pharyngeal smears, Hickman catheter and stools, 1 day before chemoprophylaxis started and then on days 5 and 9. In the case of fever, three sets of blood cultures and urine cultures were done and samples from areas related to the clinical condition were analyzed. Levofloxacin induced the selection of resistant strains or species in the flora and in the infectious agents. Fluconazole also selected resistant species in the flora. Seventeen infections were documented in eleven patients, produced by Gram-positive bacteria in thirteen cases (81.25%) and by Gram-negative bacteria in three (18.75%). The coagulase negative staphylococci and Enterococcus faecalis were the most frequent agents of infection. We identified on nine occasions the same microorganism in the flora and in the pathological product; this suggests its endogenous origin and supports the use of prospective cultures of the flora, monitoring the sensibility of the microorganisms isolated to the antimicrobials used in chemoprophylaxis and empirical treatment.
对接受大剂量化疗并进行自体血干细胞移植的中性粒细胞减少患者的菌群演变及其对不同抗菌药物的耐药性，以及这些发现与患者发生感染的病因之间的关系进行了研究，以评估所采用的化学预防和经验性抗生素治疗的适用性。在28个月的时间里对41例患者进行了分析。所采用的化学预防药物为左氧氟沙星、氟康唑和阿昔洛韦。经验性序贯治疗为初始给予头孢吡肟，随后给予替考拉宁和阿米卡星。在化学预防开始前1天以及之后的第5天和第9天，对鼻和咽涂片、希克曼导管及粪便进行培养。出现发热时，进行三组血培养和尿培养，并对与临床情况相关部位的样本进行分析。左氧氟沙星导致菌群和感染病原体中耐药菌株或菌种的选择。氟康唑也在菌群中选择了耐药菌种。11例患者共记录到17次感染，其中13例（81.25%）由革兰氏阳性菌引起，3例（18.75%）由革兰氏阴性菌引起。凝固酶阴性葡萄球菌和粪肠球菌是最常见的感染病原体。我们有9次在菌群和病理产物中鉴定出相同的微生物；这表明其为内源性来源，并支持对菌群进行前瞻性培养，监测分离出的微生物对化学预防和经验性治疗中所用抗菌药物的敏感性。
