Tusgul S, Prod'hom G, Senn L, Meuli R, Bochud P-Y, Giulieri S G
Service of Infectious Diseases, Lausanne, Switzerland; Service of Internal Medicine, Department of Medicine, Lausanne, Switzerland.
Institute of Microbiology, Department of Laboratories, Lausanne, Switzerland.
New Microbes New Infect. 2016 Nov 17;15:65-71. doi: 10.1016/j.nmni.2016.11.011. eCollection 2017 Jan.
bacteraemia can be severe, especially among patients with haematologic malignancy. We retrospectively reviewed first episodes of true bacteraemia (more than one positive bottle plus signs of infection) at our institution between 1997 and 2013 with the aim to compare haematologic versus nonhaematologic patients and analyse episodes with complicated outcome. Among 56 episodes of positive-blood cultures for 21 were considered significant. Median age was 54 years (range 23-82 years). Ten patients (48%) had a haematologic malignancy; all were neutropenic at the time of bacteraemia. Nonhaematologic patients were either intravenous drug users ( = 3, 14%), polytraumatized ( = 3, 14%) or had multiple chronic comorbidities ( = 5, 24%). Most episodes were hospital acquired (15, 71%). Sources of bacteraemia were intravascular catheter ( = 11, 52%), digestive tract ( = 6, 29%), drug injection ( = 3, 14%) and wound ( = 1, 5%). Adequate antibiotic therapy was provided to 18 patients (86%) during a median of 17 days (range 2-253 days). The intravascular catheter was removed in eight cases (42%). Three haematologic patients had a complicated course with neurologic complications (meningoencephalitis and cerebral abscesses). Complications appeared to be associated with catheter infection (100% of complicated cases vs. 29% of noncomplicated cases). In conclusion, bacteraemia can have a complicated course in a subset of patients, mainly those with haematologic malignancy. Catheter infection may be associated with a worse outcome with frequent neurologic complications.
菌血症可能很严重，尤其是在血液系统恶性肿瘤患者中。我们回顾性分析了1997年至2013年间在我院发生的首例真正菌血症（多个血培养瓶阳性加感染迹象），旨在比较血液系统疾病患者与非血液系统疾病患者，并分析预后复杂的病例。在56例血培养阳性病例中，21例被认为具有显著性。中位年龄为54岁（范围23 - 82岁）。10例患者（48%）患有血液系统恶性肿瘤；所有患者在发生菌血症时均为中性粒细胞减少。非血液系统疾病患者包括静脉吸毒者（n = 3，14%）、多发创伤患者（n = 3，14%）或患有多种慢性合并症的患者（n = 5，24%）。大多数病例是医院获得性的（15例，71%）。菌血症的来源为血管内导管（n = 11，52%）、消化道（n = 6，29%）、药物注射（n = 3，14%）和伤口（n = 1，5%）。18例患者（86%）接受了中位时间为17天（范围2 - 253天）的充分抗生素治疗。8例（42%）患者拔除了血管内导管。3例血液系统疾病患者病程复杂，出现神经系统并发症（脑膜脑炎和脑脓肿）。并发症似乎与导管感染有关（复杂病例的100% vs. 非复杂病例的29%）。总之，菌血症在一部分患者中可能病程复杂，主要是那些患有血液系统恶性肿瘤的患者。导管感染可能与更差的预后相关，常伴有神经系统并发症。
