Spinardi Julia R, Berea Rodrigo, Orioli Patricia A, Gabriele Marina M, Navarini Alessandra, Marques Marina T, Neto Milton N, Mimica Marcelo J
MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil.
PhD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil.
Germs. 2017 Jun 1;7(2):61-72. doi: 10.18683/germs.2017.1110. eCollection 2017 Jun.
Febrile neutropenia is one of the most serious treatment-related complications in cancer patients. Susceptible to rapidly progressing infections, which result in prolonged hospitalization and use of broad-spectrum antibiotics, neutropenic patients are subject to colonization by multiresistant agents, which enhances the risk of infections.
In this study we included samples collected with nasal, oropharyngeal and anal swabs from hospitalized children with febrile neutropenia following chemotherapy, between March 2014 and 2015, aiming to elucidate colonization by and spp., as well as their resistance profile.
was found in 22% of the patients and 14% of the events. Methicillin-resistant colonized 13.6% of patients. Including anal swabs in the screening increased the identification of colonized patients by 20%. spp. was found in 27% of patients and 17% of episodes. Enterococcal isolates resistant to vancomycin, accounting for 25% of the total, were not isolated in anal swabs at any time, with the oropharyngeal site being much more important. The rate of infection by spp. was 4.5% of all patients and 16% among the colonized patients.
Especially in this population, colonization studies including more sites can yield a higher chance of positive results. Establishing the colonization profile in febrile neutropenic children following chemotherapy may help to institute an empirical antibiotic treatment aimed at antibiotic adequacy and lower induction of resistance, thereby decreasing the risk of an unfavorable clinical outcome.
发热性中性粒细胞减少是癌症患者最严重的治疗相关并发症之一。中性粒细胞减少的患者易发生快速进展的感染，这会导致住院时间延长和广谱抗生素的使用，他们还容易被多重耐药菌定植，从而增加感染风险。
在本研究中，我们纳入了2014年3月至2015年期间化疗后发热性中性粒细胞减少的住院儿童的鼻腔、口咽和肛门拭子样本，旨在阐明[具体菌种1]和[具体菌种2]的定植情况及其耐药谱。
在22%的患者和14%的病例中发现了[具体菌种1]。耐甲氧西林[具体菌种1]定植于13.6%的患者。在筛查中纳入肛门拭子使定植患者的识别率提高了20%。在27%的患者和17%的病例中发现了[具体菌种2]。对万古霉素耐药的肠球菌分离株占总数的25%，在任何时候的肛门拭子中均未分离到，口咽部位更为重要。[具体菌种2]的感染率在所有患者中为4.5%，在定植患者中为16%。
特别是在这一人群中，包括更多部位的定植研究可能会有更高的阳性结果几率。确定化疗后发热性中性粒细胞减少儿童的定植情况可能有助于制定经验性抗生素治疗方案，以确保抗生素的充分性并降低耐药性的诱导，从而降低不良临床结局的风险。
