Teixeira H, Magalhães J J F, Matias C, Lyra J M A, Magalhães V, Lucena-Silva N, Melo H R L, Jucá M B, Brito C A A
Tropical Medicine Department, Federal University of Pernambuco, Recife, Brazil,
Support Care Cancer. 2014 Oct;22(10):2861-6. doi: 10.1007/s00520-014-2305-1. Epub 2014 Jun 5.
In febrile neutropenic onco-hematological patients, delayed microbiological diagnosis leads to an increase in morbidity and mortality. Identification of the microorganism changes antibiotic therapy in more than half of cases; however, in only 20-30 % of such cases pathogen isolation is achieved. This study evaluates the frequency of fungus infection and its etiology in onco-hematological patients with febrile neutropenia utilizing blood cultures and non-commercial multiplex polymerase chain reaction (MT-PCR) primers. Fifty-three febrile neutropenia episodes in 35 onco-hematological patients were observed, and the results for the first unique 30 episodes are presented. Blood cultures were positive for Candida tropicalis (one case), gram-positive bacteria (two cases), and gram-negative bacteria (four cases), showing a 23.3 % microbiological isolation rate. Multiplex-PCR pan-fungal sequence was positive in 18 cases (60 %), and further sequencing identified fugal pathogens in 11 cases (Candida glabrata and Candida parapsilosis being the most common). MT-PCR pan-fungal sequence amplification was detected in 13 of 16 patients that later received antifungal treatment for clinical reasons only, while positivity was found in 5 out of 14 patients that did not receive antifungal treatment (p = 0.02). These results show that performing in-house non-commercial MT-PCR is feasible and may provide additional information about fungal infection without the need to wait for culture results. Further research is necessary to incorporate this technology into the decision-making process.
在发热性中性粒细胞减少的肿瘤血液学患者中，微生物学诊断延迟会导致发病率和死亡率增加。在超过一半的病例中，微生物鉴定会改变抗生素治疗方案；然而，在这些病例中，只有20%-30%能够实现病原体分离。本研究利用血培养和非商业多重聚合酶链反应（MT-PCR）引物评估发热性中性粒细胞减少的肿瘤血液学患者真菌感染的频率及其病因。观察了35例肿瘤血液学患者的53次发热性中性粒细胞减少发作，并给出了前30次独特发作的结果。血培养结果显示热带念珠菌阳性（1例）、革兰氏阳性菌阳性（2例）和革兰氏阴性菌阳性（4例），微生物分离率为23.3%。多重PCR泛真菌序列在18例（60%）中呈阳性，进一步测序在11例中鉴定出真菌病原体（光滑念珠菌和近平滑念珠菌最为常见）。仅因临床原因接受抗真菌治疗的16例患者中有13例检测到MT-PCR泛真菌序列扩增，而未接受抗真菌治疗的14例患者中有5例呈阳性（p=0.02）。这些结果表明，进行内部非商业MT-PCR是可行的，无需等待培养结果即可提供有关真菌感染的额外信息。有必要进行进一步研究，将该技术纳入决策过程。
