Bakhshi Sameer, Padmanjali K S, Arya L S
Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Hematol Oncol. 2008 Jun;25(5):385-92. doi: 10.1080/08880010802106564.
A retrospective analysis was performed on febrile neutropenic episodes in patients with acute lymphoblastic leukemia (ALL) from 1992 to 2002. There were 222 febrile neutropenic episodes in 266 ALL patients with documented ANC < 500/mm(3). Of the 222 episodes, 98 (44%) had documented focus of infection; the rest were fever without focus. There were 274 different sites of infection in the 98 episodes of documented focus of infection; pulmonary infections were the commonest site of infection (27.3%) followed by HEENT (22.9%). Of 69 bacterial isolates, gram-negative bacteria (n = 46, 67%) were twice as common as gram-positive bacteria (n = 23, 33%). Most common site of isolation for gram-negative bacteria was blood (50%) followed by urine (32.6%). Blood (78.3%) was predominant site of isolation of gram-positive bacteria followed by HEENT (8.7%). Escherichia coli (45.7%) was the commonest gram-negative isolate, while Staphylococcus aureus (39%) was the commonest gram-positive bacterial isolate. There were a total of 22 fungal isolates, the majority from urine (n = 12) and HEENT (n = 9). Of the 22 fungal isolates, 19 were detected in induction phase of chemotherapy. A total of 95/222 (42.8%) febrile neutropenic episodes improved with first-line antibiotic therapy, while modification was required in 127 episodes (57.2%). Antifungal therapy was used in 86 episodes (38.7%). There were a total of 13 deaths, 6 each during induction and intensification/consolidation phases, while 1 died during maintenance phase. Of the 13 deaths, 10 had pneumonia, 8 had bacteremia, and 7 had fungal infection. The current study stresses the importance of frequent reviewing of type, frequency, severity, and outcome of infection complications over the years to detect changing epidemiological patterns. The majority of fungal infections were detected during induction chemotherapy, which highlights the need to consider this type of infection in the evaluation of patients.
对1992年至2002年急性淋巴细胞白血病（ALL）患者的发热性中性粒细胞减少发作进行了回顾性分析。266例记录的中性粒细胞绝对值（ANC）<500/mm³的ALL患者中有222次发热性中性粒细胞减少发作。在这222次发作中，98次（44%）有记录的感染灶；其余为无感染灶的发热。在98次有记录的感染灶发作中有274个不同的感染部位；肺部感染是最常见的感染部位（27.3%），其次是头、眼、耳、鼻、喉（HEENT）部位（22.9%）。在69株细菌分离物中，革兰阴性菌（n = 46，67%）的数量是革兰阳性菌（n = 23，33%）的两倍。革兰阴性菌最常见的分离部位是血液（50%），其次是尿液（32.6%）。革兰阳性菌的主要分离部位是血液（78.3%），其次是头、眼、耳、鼻、喉部位（8.7%）。大肠埃希菌（45.7%）是最常见的革兰阴性菌分离株，而金黄色葡萄球菌（39%）是最常见的革兰阳性菌分离株。共有22株真菌分离物，大多数来自尿液（n = 12）和头、眼、耳、鼻、喉部位（n = 9）。在这22株真菌分离物中，19株在化疗诱导期被检测到。222次发热性中性粒细胞减少发作中共有95次（42.8%）经一线抗生素治疗后好转，而127次发作（57.2%）需要调整治疗方案。86次发作（38.7%）使用了抗真菌治疗。共有13例死亡，诱导期和强化/巩固期各6例，维持期1例死亡。在13例死亡病例中，10例有肺炎，8例有菌血症，7例有真菌感染。本研究强调了多年来频繁回顾感染并发症的类型、频率、严重程度和结局以发现不断变化的流行病学模式的重要性。大多数真菌感染在诱导化疗期间被检测到，这突出了在评估患者时考虑此类感染的必要性。
