Gorschlüter Marcus, Mey Ulrich, Strehl John, Schmitz Volker, Rabe Christian, Pauls Katharina, Ziske Carsten, Schmidt-Wolf Ingo G H, Glasmacher Axel
Department of Internal Medicine I, University of Bonn, Germany.
BMC Infect Dis. 2006 Feb 26;6:35. doi: 10.1186/1471-2334-6-35.
Neutropenic enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal neutropenic enterocolitis.
Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal neutropenic enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal neutropenic enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature.
Among 186 articles describing patients with neutropenic enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal neutropenic enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy.
In patients with neutropenic enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in neutropenic enterocolitis.
中性粒细胞减少性小肠结肠炎是一种危及生命的并发症，最常发生于急性白血病强化化疗后。革兰氏阴性菌是最重要的致病病原体组。也有真菌的报道，但其实际相关性仍不清楚。指南未涉及真菌性中性粒细胞减少性小肠结肠炎的具体治疗建议。
在此，我们进行了一项荟萃分析，以回答以下问题：真菌性中性粒细胞减少性小肠结肠炎的发生率和死亡率是多少？致病真菌的发生率和微生物分布是否支持经验性抗真菌治疗？已记录的真菌性中性粒细胞减少性小肠结肠炎中抗真菌治疗的报告结果是否有助于选择合适的药物？经过系统检索，我们从完整的文献中提取并总结了所有详细数据。
在186篇描述中性粒细胞减少性小肠结肠炎患者的文章中，我们发现29篇报告描述了53例有致病真菌病原体的患者。我们未发现关于抗真菌治疗作用的随机对照试验、高质量队列研究或高质量病例对照研究。从所有860例报告患者计算得出的真菌性中性粒细胞减少性小肠结肠炎合并发生率为6.2%，仅从选定的代表性研究计算得出的为3.4%。94%的患者涉及念珠菌属。合并死亡率为81.8%。大多数作者未报告或未进行抗真菌治疗。
在中性粒细胞减少性小肠结肠炎患者中，真菌病原体与细菌相比起相关但次要的作用。关于治疗的证据非常少，但本研究的流行病学数据可能为中性粒细胞减少性小肠结肠炎经验性抗真菌治疗的选择提供有用线索。
