Cattaneo Chiara, Casari Salvatore, Bracchi Francesca, Signorini Liana, Ravizzola Giuseppe, Borlenghi Erika, Re Alessandro, Manca Nino, Carosi Giampiero, Rossi Giuseppe
UO Ematologia, Spedali Civili, Universit à di Brescia, Brescia, Italy.
Scand J Infect Dis. 2010 May;42(5):324-32. doi: 10.3109/00365540903496569.
We prospectively analysed the microbiological isolates of all febrile/infectious episodes occurring at our haematology unit during 2 consecutive 18-month periods. Microbiologically documented infections (MDI) and antibiotic resistance were correlated with type and status of haematological disease, neutropenia, levofloxacin prophylaxis, central venous catheter and clinical outcome. Three hundred and ten MDI were observed and 369 pathogens were isolated. Gram-negative bacteria represented 49.3% and Gram-positive bacteria 40.9% of all pathogens. Fungal infections represented only 8.9% of MDI. A significant decrease in Staphylococcus aureus (p < 0.001) and an increase in enterococci, viridans streptococci and Pseudomonas spp. (p = 0.004) were observed during the second period. Four multiresistant (Multi-R) Pseudomonas were isolated, all during the last 12 months. The death rate in MDI was 8.7%, bacteria accounting for 70.4% of them. Enterococci, streptococci and Pseudomonas spp. infections were involved in 44.4% of MDI with an unfavourable outcome. Multi-R pathogens were involved in 4 cases (3 vancomycin-resistant enterococci and 1 Multi-R Pseudomonas), their death rate being 25%. Multivariate analysis showed that an infection due to a mycotic or a Multi-R pathogen was associated with an unfavourable outcome. The recent emergence of enterococci, viridans streptococci and Pseudomonas spp., particularly if Multi-R, is a major concern in haematological patients.
我们对血液科在连续两个18个月期间发生的所有发热/感染性发作的微生物分离株进行了前瞻性分析。微生物学确诊的感染（MDI）和抗生素耐药性与血液系统疾病的类型和状态、中性粒细胞减少、左氧氟沙星预防、中心静脉导管及临床结局相关。共观察到310例MDI，分离出369种病原体。革兰氏阴性菌占所有病原体的49.3%，革兰氏阳性菌占40.9%。真菌感染仅占MDI的8.9%。在第二个时期，观察到金黄色葡萄球菌显著减少（p<0.001），肠球菌、草绿色链球菌和假单胞菌属增加（p=0.004）。分离出4株多重耐药（Multi-R）假单胞菌，均在过去12个月内。MDI的死亡率为8.7%，其中细菌占70.4%。肠球菌、链球菌和假单胞菌属感染导致44.4%的MDI预后不良。Multi-R病原体涉及4例（3株耐万古霉素肠球菌和1株Multi-R假单胞菌），其死亡率为25%。多变量分析显示，真菌或Multi-R病原体感染与不良结局相关。肠球菌、草绿色链球菌和假单胞菌属的近期出现，尤其是多重耐药的情况，是血液科患者的主要担忧。
