Klastersky J, Ameye L, Maertens J, Georgala A, Muanza F, Aoun M, Ferrant A, Rapoport B, Rolston K, Paesmans M
Data Centre, Institut Jules Bordet, Rue Héger-Bordet, 1B - 1000 Brussels, Belgium.
Int J Antimicrob Agents. 2007 Nov;30 Suppl 1:S51-9. doi: 10.1016/j.ijantimicag.2007.06.012. Epub 2007 Aug 8.
A total of 2142 patients with febrile neutropenia resulting from cancer chemotherapy were registered in two observational studies and followed prospectively in different institutions. There were 499 (23%) patients with bacteraemia who are reviewed here. The relative frequencies of Gram-positive, Gram-negative and polymicrobial bacteraemias were 57%, 34% and 10% with respective mortality rates of 5%, 18% and 13%. Mortality rates were significantly higher in bacteraemic patients than in non-bacteraemic patients; a trend for higher mortality was observed (without reaching statistical significance) in those patients in whom bacteraemia was associated with a clinical site of infection compared to bacteraemic patients without any clinical documentation. Prophylactic antibiotics but not granulopoiesis stimulating factors were associated with a lower incidence of Gram-negative bacteraemia; however, neither prophylactic approach influenced the subsequent rate of complications in the patients who developed bacteraemia. The present study also confirms that the MASCC scoring system can identify a group of bacteraemic patients with a relatively low risk of complications and death (MASCC >/=21). On the other hand, in patients with very low levels of the MASCC score (<15), and then with predicted very unfavourable risk, the rate of complications and death was dramatically high, irrespective of the microbiological nature of the bacteraemia.
共有2142例因癌症化疗导致发热性中性粒细胞减少的患者被纳入两项观察性研究，并在不同机构进行前瞻性随访。本文回顾了其中499例（23%）发生菌血症的患者。革兰氏阳性菌、革兰氏阴性菌和混合菌血症的相对发生率分别为57%、34%和10%，相应的死亡率分别为5%、18%和13%。菌血症患者的死亡率显著高于非菌血症患者；与无任何临床记录的菌血症患者相比，菌血症与临床感染部位相关的患者有更高死亡率的趋势（未达到统计学显著性）。预防性使用抗生素而非粒细胞生成刺激因子与革兰氏阴性菌血症的发生率较低相关；然而，两种预防方法均未影响发生菌血症患者随后的并发症发生率。本研究还证实，MASCC评分系统可以识别出一组并发症和死亡风险相对较低的菌血症患者（MASCC≥21）。另一方面，在MASCC评分非常低（<15）且预测风险非常不利的患者中，无论菌血症的微生物学性质如何，并发症和死亡率都非常高。
