Roongpoovapatr Pitiya, Suankratay Chusana
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2010 Jul;93(7):776-83.
Infections cause substantial morbidity and morbidity in neutropenic patients. In King Chulalongkorn Memorial Hospital, Gram-negative bacteria remained the most common causative pathogen of febrile neutropenia in all three studies conducted before 2002. However, Gram-positive bacteria have become more commonly isolated etiologic pathogens, and the incidence of fungal infection has been increasing since 2005.
Determine the infectious etiology of fever in neutropenic patients at King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
A retrospective chart review of all medical records of febrile neutropenic patients hospitalized at Department of Medicine between January 1 and December 31, 2006 in accompanying with microbiologic, radiologic, and serologic results was analyzed.
There were 125 patients (61 males and 64 females) and 172 episodes of febrile neutropenia with a mean age of 46.5 +/- 18.5 years (range: 15-81 years). The three most common primary diseases associated with neutropenia were acute myeloid leukemia, non-Hodgkin's lymphoma, and acute lymphoblastic leukemia (36.6%, 33.1%, and 10.5%). Infections could be documented microbiologically and clinically in 84 episodes (48.8%), and primary bacteremia or fungemia was the most common cause of infection (40.5%). Gram-negative bacteria were the most frequently isolated pathogens (63.9%), followed by Gram-positive bacteria (29.9%) and fungi (6.2%). Escherichia coli (46.8%) and coagulase-negative Staphylococcus (27.6%) were the most common isolates among Gram-negative and Gram-positive bacteria, respectively. Among 53 episodes (30.8%) of bloodstream infections, Gram-negative bacteria were the most commonly isolated pathogens (38 episodes, 71.7%), followed by Gram-positive bacteria (19 episodes, 35.8%) and Candida tropicalis (1 episode, 1.9%). Surprisingly, invasive mold infections were noted in eight episodes (5, 1, and 2 episodes of proven, probable, and possible infections, respectively). The overall mortality was 19.2%.
Although Gram-negative bacteria are the most common etiology of fever in neutropenic patients, the occurrence of infections caused by coagulase-negative Staphylococcus and molds has been increasing in comparison with the observations from previous studies in King Chulalongkorn Memorial Hospital. To authors knowledge, the present study is the first in Thailand to determine the occurrence of invasive fungal infections using the standard criteria recommended by EORTC/MSG.
感染在中性粒细胞减少患者中会导致严重的发病和死亡。在朱拉隆功国王纪念医院，在2002年之前进行的三项研究中，革兰氏阴性菌仍是发热性中性粒细胞减少最常见的致病病原体。然而，革兰氏阳性菌已成为更常见的分离病原，并且自2005年以来真菌感染的发生率一直在上升。
确定泰国曼谷朱拉隆功国王纪念医院中性粒细胞减少患者发热的感染病因。
对2006年1月1日至12月31日在医学部住院的发热性中性粒细胞减少患者的所有病历进行回顾性图表分析，并结合微生物学、放射学和血清学结果。
共有125例患者（男性61例，女性64例），发生172次发热性中性粒细胞减少，平均年龄为46.5±18.5岁（范围：15 - 81岁）。与中性粒细胞减少相关的三种最常见的原发性疾病是急性髓系白血病、非霍奇金淋巴瘤和急性淋巴细胞白血病（分别为36.6%、33.1%和10.5%）。84次发作（48.8%）的感染可通过微生物学和临床方法记录，原发性菌血症或真菌血症是最常见的感染原因（40.5%）。革兰氏阴性菌是最常分离出的病原体（63.9%），其次是革兰氏阳性菌（29.9%）和真菌（6.2%）。大肠杆菌（46.8%）和凝固酶阴性葡萄球菌（27.6%）分别是革兰氏阴性菌和革兰氏阳性菌中最常见的分离菌。在53次血流感染发作（30.8%）中，革兰氏阴性菌是最常分离出的病原体（38次发作，71.7%），其次是革兰氏阳性菌（19次发作，35.8%）和热带念珠菌（1次发作，1%）。令人惊讶的是，发现8次侵袭性霉菌感染（分别为确诊、可能和疑似感染5次、1次和2次）。总死亡率为19.2%。
尽管革兰氏阴性菌是中性粒细胞减少患者发热最常见的病因，但与朱拉隆功国王纪念医院之前的研究观察结果相比，凝固酶阴性葡萄球菌和霉菌引起的感染有所增加。据作者所知，本研究是泰国首次按照欧洲癌症研究与治疗组织/美国国立医学研究院（EORTC/MSG）推荐的标准来确定侵袭性真菌感染的发生率。
