Velasco E, Byington R, Martins C A S, Schirmer M, Dias L M C, Gonçalves V M S C
Rua General Glicério 486/1002, Cep 22245-120, Rio de Janeiro, Brazil.
Eur J Clin Microbiol Infect Dis. 2006 Jan;25(1):1-7. doi: 10.1007/s10096-005-0077-8.
A total of 399 consecutive episodes of bloodstream infections in adult patients with haematologic malignancies and solid tumours were evaluated prospectively over a 26-month period, with the aim of determining the clinical characteristics and the microbiological profile of the patients relative to neutrophil count. The overall 30-day mortality rate was 32% (35% in non-neutropenic patients vs. 26% in neutropenic patients, p=0.05). Main diagnoses were solid tumours (33%) and lymphoma (29%). Most of the episodes of bloodstream infection (58%) occurred in non-neutropenic patients. Acute leukaemia and bone marrow transplantation predominated in the neutropenic group. Non-neutropenic patients tended to be older and to have a higher frequency of solid tumours and advanced or uncontrolled diseases. Indwelling central venous catheters were present in 51% of the episodes, with a predominance of long-term catheters in neutropenic haematologic patients. Concomitant infections were observed more frequently in non-neutropenic patients. There were 1,040 noninfectious comorbid conditions, most of which were present in non-neutropenic patients. The causative pathogens were predominantly gram-negative bacilli (56%). Escherichia coli and Klebsiella pneumoniae were isolated more frequently from neutropenic patients, while Staphylococcus aureus and Acinetobacter spp. were more frequent in non-neutropenic patients. Seventy-four percent of the episodes of candidaemia occurred in patients with central venous catheters, with non-albicans strains predominating. The results of this study highlight the heterogeneity of cancer patients with bloodstream infections and the value of stratifying risk factors and aetiologic agents according to neutrophil count.
在26个月的时间里，对399例成年血液系统恶性肿瘤和实体瘤患者连续发生的血流感染进行了前瞻性评估，目的是确定患者相对于中性粒细胞计数的临床特征和微生物学特征。总体30天死亡率为32%（非中性粒细胞减少患者为35%，中性粒细胞减少患者为26%，p = 0.05）。主要诊断为实体瘤（33%）和淋巴瘤（29%）。大多数血流感染发作（58%）发生在非中性粒细胞减少患者中。中性粒细胞减少组以急性白血病和骨髓移植为主。非中性粒细胞减少患者往往年龄较大，实体瘤、晚期或未控制疾病的发生率较高。51%的发作病例存在留置中心静脉导管，中性粒细胞减少的血液系统疾病患者中以长期导管为主。非中性粒细胞减少患者更常观察到合并感染。共有1040种非感染性合并症，其中大多数存在于非中性粒细胞减少患者中。致病病原体主要是革兰氏阴性杆菌（56%）。大肠杆菌和肺炎克雷伯菌在中性粒细胞减少患者中分离频率更高，而金黄色葡萄球菌和不动杆菌属在非中性粒细胞减少患者中更常见。74%的念珠菌血症发作发生在有中心静脉导管的患者中，以非白色念珠菌菌株为主。本研究结果突出了血流感染癌症患者的异质性，以及根据中性粒细胞计数对危险因素和病原体进行分层的价值。
