Menichetti F, Del Favero A
Institute of Infectious Diseases, Perugia University, Italy.
J Antimicrob Chemother. 1991 Apr;27 Suppl B:51-60. doi: 10.1093/jac/27.suppl_b.51.
The increasing prevalence of Gram-positive infections in neutropenic cancer patients seems to be related to the use of central venous catheters, chemotherapy-induced oral and gastrointestinal mucositis, and the prophylactic use of fluoroquinolones. The need for anti-Gram-positive therapy in the neutropenic patient is supported by the increasing prevalence and the changing resistance of Gram-positive pathogens, as well as by the poor response of Gram-positive bacteraemia to aminoglycoside plus beta-lactam regimens. Combined therapy with either vancomycin or teicoplanin and other empirical antibiotics, has proved efficacious in adults and children with neutropenia, fever and Gram-positive infection. Vancomycin exerts greater antibacterial activity against strains of coagulase-negative staphylococci than teicoplanin and there is more data on its routine clinical use. In its favour, teicoplanin is less toxic and easier to administer. The time when a glycopeptide antibiotic should be introduced is still a matter of debate; support for both initial therapy and subsequent rescue therapy is found in the current literature. Large clinical trials are warranted to clarify further the role of anti-Gram-positive therapy in the neutropenic patient.
中性粒细胞减少的癌症患者中革兰氏阳性菌感染患病率不断上升，这似乎与中心静脉导管的使用、化疗引起的口腔和胃肠道黏膜炎以及氟喹诺酮类药物的预防性使用有关。革兰氏阳性病原体患病率的上升和耐药性的变化，以及革兰氏阳性菌血症对氨基糖苷类药物加β-内酰胺类药物治疗方案反应不佳，都支持在中性粒细胞减少的患者中进行抗革兰氏阳性菌治疗。在患有中性粒细胞减少、发热和革兰氏阳性菌感染的成人和儿童中，万古霉素或替考拉宁与其他经验性抗生素联合治疗已被证明是有效的。万古霉素对凝固酶阴性葡萄球菌菌株的抗菌活性比替考拉宁更强，并且关于其常规临床应用的数据更多。替考拉宁的优势在于毒性较小且易于给药。糖肽类抗生素何时开始使用仍存在争议；目前的文献中既有支持初始治疗的，也有支持后续挽救治疗的。有必要进行大型临床试验，以进一步明确抗革兰氏阳性菌治疗在中性粒细胞减少患者中的作用。
