Rotstein C, Higby D, Killion K, Powell E
Department of Medical Oncology, Roswell Park Memorial Institute, Buffalo, NY 14263.
J Surg Oncol. 1988 Nov;39(3):154-8. doi: 10.1002/jso.2930390304.
A total of 64 episodes of bacteremia and fungemia were documented in 25 allogeneic bone marrow transplant recipients. Coagulase-negative staphylococci were the most common pathogens recovered, with 34 of the 39 isolated being methicillin resistant. Streptococcus viridans (11 episodes), diphtheroids (5 episodes), and Pseudomonas aeruginosa (4 episodes) accounted for the majority of the other pathogens causing bacteremia. Six episodes of fungemia were also seen. Coagulase-negative staphylococci were demonstrated in 31 of 36 (86%) throat cultures, 25 of 35 (71%) stool cultures, and 6 of 7 (86%) Hickman or Broviac catheter exit site surveillance cultures prior to the development of bacteremia caused by these organisms. Throat surveillance cultures positive for S. viridans also showed a correlation (88%) with subsequent S. viridans bacteremia. However, surveillance cultures for aerobic gram-negative bacilli, diphtheroids, and fungi did not correlate with subsequent septicemia. Organisms isolated in throat surveillance cultures correlated with subsequent bacteremia caused by these organisms in only 15% of all the cultures taken, while only 14% of stool cultures predicted bacteremia. The utility of surveillance cultures is limited because of low cost-effectiveness and a high rate of false-positive results.
在25名异基因骨髓移植受者中，共记录到64例菌血症和真菌血症发作。凝固酶阴性葡萄球菌是最常分离出的病原体，39株分离菌中有34株对甲氧西林耐药。草绿色链球菌（11例）、类白喉杆菌（5例）和铜绿假单胞菌（4例）是导致菌血症的其他主要病原体。还观察到6例真菌血症。在这些微生物引起菌血症之前，36份咽喉培养物中有31份（86%）、35份粪便培养物中有25份（71%）以及7份Hickman或Broviac导管出口部位监测培养物中有6份（86%）检出凝固酶阴性葡萄球菌。草绿色链球菌咽喉监测培养阳性与随后发生的草绿色链球菌菌血症也存在相关性（88%）。然而，需氧革兰氏阴性杆菌、类白喉杆菌和真菌的监测培养与随后的败血症并无相关性。咽喉监测培养物中分离出的微生物仅在所有培养物的15%中与这些微生物随后引起的菌血症相关，而粪便培养物仅14%能预测菌血症。由于成本效益低和假阳性结果发生率高，监测培养的实用性有限。
