Division of Pulmonary Medicine, Rambam Health Care Campus, 8 Ha'Aliya Street, 31096, Haifa, Israel.
Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Infection. 2016 Aug;44(4):491-7. doi: 10.1007/s15010-016-0873-3. Epub 2016 Jan 20.
The frequency and clinical significance of polymicrobial pneumonia in patients with hematological malignancies (HM) are poorly understood. The aim of the present study is to describe the prevalence, risk factors, clinical characteristics, and outcome of patients with HM and polymicrobial pneumonia.
Over a 5 year period, 436 consecutive adult patients with HM and pulmonary infiltrates underwent diagnostic fiberoptic bronchoscopy with bronchoalveolar lavage. For 219 patients an infectious etiology was diagnosed, of them 45 (20.5 %) had polymicrobial etiology. Risk factors, clinical course and outcome of polymicrobial pulmonary infection in patients with HM were established.
45 patients with HM were identified with polymicrobial pulmonary infection, 39 of them with two pathogens, and 6 with three. The most common co-pathogen identified was Aspergillus sp. (87 %). Allogeneic hematopoietic stem cell transplantation (HSCT) and graft versus host disease (GVHD) were predictors of polymicrobial infection. Compared to patients with monomicrobial pneumonia, patients with polymicrobialpulmonary infection had a more severe clinical course with more dyspnea (69 vs. 49 %, P = 0.016), hemoptysis (16 vs. 7 %, P = 0.065) and more required respiratory support (27 vs. 17 %, P = 0.125). In-hospital mortality was significantly higher in patients with polymicrobial pulmonary infection than in patients with monomicrobial pulmonary infection (49 vs. 19 %, P < 0.001).
Polymicrobial pulmonary infection occurs quite frequently in patients with HM, especially in allogeneic HSCT recipients and in patients with GVHD. The clinical course of polymicrobial pulmonary infection is severe and mortality approaches 50 %. The clinician taking care of these patients should always look for additional copathogens in profoundly immunosuppressed patients with pneumonia.
血液恶性肿瘤（HM）患者中，关于混合性细菌性肺炎的频率和临床意义尚不清楚。本研究旨在描述 HM 患者中混合性细菌性肺炎的患病率、危险因素、临床特征和结局。
在 5 年期间，对 436 例接受诊断性纤维支气管镜检查和支气管肺泡灌洗的 HM 成年患者进行了研究。在 219 例患者中诊断出感染性病因，其中 45 例（20.5%）为混合性细菌性病因。确定了 HM 患者混合性肺部感染的危险因素、临床过程和结局。
45 例 HM 患者被确定为混合性肺部感染，其中 39 例有两种病原体，6 例有三种病原体。最常见的合并病原体为曲霉菌属（87%）。异基因造血干细胞移植（HSCT）和移植物抗宿主病（GVHD）是混合性感染的预测因素。与单一致病菌性肺炎患者相比，混合性肺部感染患者的临床过程更严重，呼吸困难（69% vs. 49%，P=0.016）、咯血（16% vs. 7%，P=0.065）和需要呼吸支持的比例更高（27% vs. 17%，P=0.125）。混合性肺部感染患者的住院死亡率明显高于单一致病菌性肺部感染患者（49% vs. 19%，P<0.001）。
HM 患者中混合性肺部感染相当常见，尤其是在异基因 HSCT 受者和 GVHD 患者中。混合性肺部感染的临床过程严重，死亡率接近 50%。治疗这些患者的临床医生应始终在肺炎免疫抑制严重的患者中寻找其他合并病原体。
