Faculté de Médecine, Laboratoire EA 3826, Thérapeutiques Cliniques et Expérimentales des Infections, Université de Nantes, 1 Rue G Veil, 44000 Nantes, France.
Eur J Clin Microbiol Infect Dis. 2013 Jul;32(7):841-50. doi: 10.1007/s10096-013-1819-7. Epub 2013 Jan 25.
Bacteremia remains a major cause of life-threatening complication in patients with cancer. Significant changes in the spectrum of microorganisms isolated from blood culture have been reported in cancer patients over the past years. The aim of our systematic review was to inventory the recent trends in epidemiology and antibiotic resistance of microorganisms causing bacteremia in cancer patients. Data for this review was identified by searches of Medline, Scopus and Cochrane Library for indexed articles and abstracts published in English since 2008. The principal search terms were: "antimicrobial resistance", "bacteremia", "bacterial epidemiology", "bloodstream infection", "cancer patients", "carbapenem resistance", "Escherichia coli resistance", "extended-spectrum β-lactamase producing E. coli", "febrile neutropenia", "fluoroquinolone resistance", "neutropenic cancer patient", "vancomycin-resistant Enterococcus", and "multidrug resistance". Boolean operators (NOT, AND, OR) were also used in succession to narrow and widen the search. Altogether, 27 articles were selected to be analyzed in the review. We found that Gram-negative bacteria were the most frequent pathogen isolated, particularly in studies with minimal use of antibiotic prophylaxis. Another important trend is the extensive emergence of antimicrobial-resistant strains associated with increased risk of morbidity, mortality and cost. This increasing incidence of antibiotic resistance has been reported in Gram-negative bacteria as well as in Gram-positive bacteria. This exhaustive review, reporting the recent findings in epidemiology and antibiotic resistance of bacteremia in cancer patients, highlights the necessity of local continuous surveillance of bacteremia and stringent enforcement of antibiotic stewardship programs in cancer patients.
菌血症仍然是癌症患者发生危及生命的并发症的主要原因。近年来，癌症患者血液培养中分离出的微生物的种类发生了显著变化。我们的系统评价旨在总结近期癌症患者菌血症的流行病学和抗生素耐药性的变化趋势。本研究通过在 Medline、Scopus 和 Cochrane Library 中检索 2008 年以来发表的英文索引文章和摘要，获取了用于本综述的数据。主要的搜索词包括：“抗生素耐药性”、“菌血症”、“细菌流行病学”、“血流感染”、“癌症患者”、“碳青霉烯耐药”、“大肠杆菌耐药”、“产超广谱β-内酰胺酶的大肠杆菌”、“发热性中性粒细胞减少症”、“氟喹诺酮耐药”、“中性粒细胞减少症癌症患者”、“耐万古霉素肠球菌”和“多重耐药”。还使用了布尔运算符（NOT、AND、OR）进行连续的缩小和扩大搜索。总共选择了 27 篇文章进行分析。我们发现，革兰氏阴性菌是最常见的病原体，尤其是在抗生素预防措施使用最少的研究中。另一个重要趋势是与发病率、死亡率和成本增加相关的广泛出现的抗生素耐药菌株。革兰氏阴性菌和革兰氏阳性菌都报告了抗生素耐药性的增加。这项详尽的综述报告了癌症患者菌血症的流行病学和抗生素耐药性的最新发现，强调了对菌血症进行局部持续监测和严格执行癌症患者抗生素管理计划的必要性。
