Baskaran Nirmala Devi, Gan Gin Gin, Adeeba Kamarulzaman, Sam I-Ching
Department of Medicine, Kajang Hospital, Kajang, Selangor, Malaysia.
Int J Infect Dis. 2007 Nov;11(6):513-7. doi: 10.1016/j.ijid.2007.02.002. Epub 2007 Apr 24.
This study was initiated to determine the local profile of blood culture isolates and antibiotic sensitivities in febrile neutropenic patients following chemotherapy, and to establish if any modifications to treatment guidelines are necessary.
A total of 116 episodes of febrile neutropenia admitted to the adult hematology ward at a university medical center in Malaysia were studied retrospectively from January 2004 to January 2005.
The study showed 43.1% of febrile neutropenic episodes had established bacteremia. Gram-negative bacteria accounted for 60.3% of isolates. Sensitivities of Gram-negative bacteria to the antibiotics recommended in the Infectious Diseases Society of America (IDSA) guidelines were 86.1-97.2%. Coagulase-negative staphylococci were the most common Gram-positive organisms isolated (23.3%). The majority of these were methicillin-resistant.
Carbapenem monotherapy, as recommended in the 2002 IDSA guidelines, is effective treatment for the infections most often encountered at our center. Combination therapy with an aminoglycoside should be considered when using ceftazidime, cefepime or piperacillin-tazobactam, particularly in high-risk patients. Vancomycin should be used if a Gram-positive organism is suspected or isolated.
开展本研究以确定化疗后发热性中性粒细胞减少患者的血培养分离菌的本地情况及抗生素敏感性，并确定是否有必要对治疗指南进行任何修改。
对2004年1月至2005年1月期间马来西亚一所大学医学中心成人血液科收治的116例发热性中性粒细胞减少发作进行回顾性研究。
研究表明，43.1%的发热性中性粒细胞减少发作已确诊菌血症。革兰氏阴性菌占分离菌的60.3%。革兰氏阴性菌对美国传染病学会（IDSA）指南中推荐的抗生素的敏感性为86.1%至97.2%。凝固酶阴性葡萄球菌是最常见的分离出的革兰氏阳性菌（23.3%）。其中大多数是耐甲氧西林的。
2002年IDSA指南中推荐的碳青霉烯单药治疗对我们中心最常遇到的感染是有效的治疗方法。使用头孢他啶、头孢吡肟或哌拉西林-他唑巴坦时，应考虑与氨基糖苷类药物联合治疗，尤其是在高危患者中。如果怀疑或分离出革兰氏阳性菌，应使用万古霉素。
