Department of Infectious Diseases, Amiens University Medical Center, France.
BMC Infect Dis. 2011 Jun 27;11:183. doi: 10.1186/1471-2334-11-183.
The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.
We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm(3)) and fever (temperature > 38.3°C).
The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. Staphylococcus species (mainly S. aureus) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm(3).
Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.
用于治疗肺癌的化疗会导致 10%至 40%的患者出现发热性中性粒细胞减少症。虽然大多数病例的病因不明，但 30%的病例可怀疑为感染性病因。鉴于有关肺癌发热性中性粒细胞减少症患者的数据有限，我们对法国北部皮卡第地区的三个医疗中心记录的病例的微生物学特征进行了回顾性研究。
我们分析了中性粒细胞减少症（中性粒细胞计数<500/mm(3)）和发热（体温>38.3°C）的肺癌患者的病历。
该研究纳入了 87 例肺癌发热性中性粒细胞减少症患者（平均年龄：64.2 岁）。三分之二的患者有转移，一半的患者有较差的表现状态。87 例中有 33 例的病例得到了微生物学证实。这些病例中 59%的为革兰氏阴性菌（主要来自泌尿道和消化道的肠杆菌科）。革兰氏阳性菌中主要为葡萄球菌属（主要为金黄色葡萄球菌）。血培养阳性率为 23%。有 14%的感染可能为医院获得性感染，14%的感染由多药耐药菌株引起。第 30 天的总体死亡率为 33%，感染相关死亡率为 16.1%。抗生素治疗的成功率为 82.8%。在多变量分析中，治疗失败的预测因素为年龄>60 岁和血小板计数<20000/mm(3)。
在发热性中性粒细胞减少症的肺癌患者中，最常鉴定到的细菌为革兰氏阴性菌。尽管抗生素治疗成功且患者中性粒细胞减少症风险较低，但该特定人群的死亡率仍较高。
