Gutiérrez J, Bronfman L, Lorca J, Pinto M E, Torrens M, Garcia M E, Barrientos A, Palma T
Rev Med Chil. 1989 Oct;117(10):1141-9.
We analyzed infections complicating 140 episodes of severe neutropenia in 86 patients. The underlying diagnosis was acute leukemia in 64, lymphoma in 12 and isolated cases of bone marrow aplasia, agranulocytosis, dysmyelopoiesis and solid tumors. No fever developed in 35 (25%) episodes. No cause for the fever was identified in 40% of the remaining episodes. Clinical evidence of an infection was present in 20%, with positive bacteriologic findings in 27%. Respiratory infection (16%), pneumonia (11%) and sepsis (10%) were the most common infectious processes. Infectious agents isolated were gram negative bacilli (72%), gram positive cocci (19%) and fungi (9%). The association of amikacin and carbenicillin or cephalosporins proved to be superior to gentamycin-penicillin (p less than 0.01). 16 patients died for an overall mortality of 11%. Pneumonia and infection by K pneumoniae or C albicans were associated to a poorer prognosis.
我们分析了86例患者中140次严重中性粒细胞减少症并发感染的情况。潜在诊断为急性白血病64例，淋巴瘤12例，以及骨髓再生障碍、粒细胞缺乏症、骨髓生成异常和实体瘤的孤立病例。35次（25%）发作未出现发热。其余发作中40%未发现发热原因。20%有感染的临床证据，27%有阳性细菌学检查结果。呼吸道感染（16%）、肺炎（11%）和败血症（10%）是最常见的感染过程。分离出的感染病原体为革兰氏阴性杆菌（72%）、革兰氏阳性球菌（19%）和真菌（9%）。阿米卡星与羧苄青霉素或头孢菌素联合使用被证明优于庆大霉素-青霉素（p<0.01）。16例患者死亡，总死亡率为11%。肺炎以及肺炎克雷伯菌或白色念珠菌感染与较差的预后相关。
