中性粒细胞减少症癌症患者血流感染：血液系统恶性肿瘤和实体瘤患者之间的差异。
Bloodstream infections in neutropenic patients with cancer: differences between patients with haematological malignancies and solid tumours.
机构信息
Oncology Department, ICO (Institut Català d'Oncologia) l'Hospitalet, ICO Duran i Reynals, University of Barcelona, Barcelona, Spain.
Infectious Disease Service, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, University of Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain.
出版信息
J Infect. 2014 Nov;69(5):417-23. doi: 10.1016/j.jinf.2014.05.018. Epub 2014 Jun 21.
OBJECTIVES
We sought to identify the characteristics, aetiology, antibiotic resistance and outcomes of bloodstream infection (BSI) in neutropenic patients with haematological malignancies (HM) and in those with solid tumours (ST) and assess their impact on empirical therapy and outcomes.
METHODS
All episodes of BSI in neutropenic patients with HM and ST were prospectively recorded and compared.
RESULTS
Of 579 episodes of BSI, 493 occurred in patients with HM and 86 in patients with ST. An endogenous source and catheter-related infection were more frequent in patients with HM, whereas pneumonia and urinary tract were more common in the ST group. BSI was mainly due to Gram-negative bacilli. Coagulase-negative staphylococci were more frequent in patients with HM, while Pseudomonas aeruginosa was more common in patients with ST and was the leading cause of pneumonia. Multidrug-resistant Gram-negative bacilli (MDRGNB) were more frequently isolated in haematological patients who more often received inadequate empirical therapy than those with ST. Case-fatality rates were higher in patients with ST.
CONCLUSIONS
We identified significant differences in BSI in neutropenic patients with HM and ST. MDRGNB were more often isolated in patients with HM. Pneumonia due to P. aeruginosa was particularly frequent among patients with ST. Case-fatality rates were higher in patients with ST.
目的
本研究旨在鉴定血液感染（BSI）在血液恶性肿瘤（HM）和实体肿瘤（ST）中性粒细胞减少症患者中的特征、病因、抗生素耐药性和结局，并评估其对经验性治疗和结局的影响。
方法
前瞻性记录和比较了 HM 和 ST 中性粒细胞减少症患者所有 BSI 发作的特征。
结果
579 例 BSI 中，493 例发生在 HM 患者中，86 例发生在 ST 患者中。HM 患者中内源性和导管相关感染更为常见，而 ST 组中肺炎和尿路感染更为常见。BSI 主要由革兰氏阴性杆菌引起。凝固酶阴性葡萄球菌在 HM 患者中更为常见，而铜绿假单胞菌在 ST 患者中更为常见，是肺炎的主要病原体。与 ST 患者相比，HM 患者更常分离出耐多药革兰氏阴性杆菌（MDRGNB），且更常接受不充分的经验性治疗。ST 患者的病死率更高。
结论
我们发现 HM 和 ST 中性粒细胞减少症患者的 BSI 存在显著差异。HM 患者中更常分离出 MDRGNB。ST 患者中由铜绿假单胞菌引起的肺炎尤为常见。ST 患者的病死率更高。
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