Russo Rachel, Mendes Elisa Teixeira, Levin Anna Sara, Dulley Frederico, Oliveira Maura S, Shikanai-Yasuda Maria Aparecida, Costa Silvia Figueiredo
Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.
Pontifícia Universidade Católica de Campinas, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Campinas. São Paulo, Brazil.
Rev Inst Med Trop Sao Paulo. 2018 Dec 20;61:e3. doi: 10.1590/S1678-9946201961003.
We described 235 bloodstream infection (BSI) episodes in 146 hematopoietic stem cell transplantation (HSCT) outpatients and evaluated risk factors for hospitalization and death. Records of outpatients presenting with positive blood cultures over a 5-year period (January 2005 to December 2008) were reviewed. Variables with p< 0.1 in bivariate analysis were used in a regression logistic model. A total of 266 agents were identified, being 175 (66.7%) gram-negative, 80 (30.3%) gram-positive bacteria and 9 (3.4%) fungi. The most common underlying disease was acute leukemia 40 (27.4%), followed by lymphoma non-Hodgkin 26 (18%) and 87 patients (59.6%) were submitted to allogeneic hematopoietic stem cell transplant (HSCT). BSI episodes were more frequent during the first 100 days after transplantation (183 or 77.8%), and ninety-one (38.7%) episodes of BSI occurred up to the first 30 days. Hospitalization occurred in 26% of the episodes and death in 10% of cases. Only autologous HSCT was protector for hospitalization. Although, central venous catheter (CVC) withdrawal and the Multinational Association of Supportive Care in Cancer (MASCC) score up to 21 points were protector factors for death in the bivariate analysis, only MASCC remained as protector.
我们描述了146例造血干细胞移植（HSCT）门诊患者中的235次血流感染（BSI）发作，并评估了住院和死亡的危险因素。回顾了5年期间（2005年1月至2008年12月）血培养呈阳性的门诊患者记录。在二元分析中p<0.1的变量用于回归逻辑模型。共鉴定出266种病原体，其中革兰氏阴性菌175种（66.7%），革兰氏阳性菌80种（30.3%），真菌9种（3.4%）。最常见的基础疾病是急性白血病40例（27.4%），其次是非霍奇金淋巴瘤26例（18%），87例患者（59.6%）接受了异基因造血干细胞移植（HSCT）。BSI发作在移植后的前100天更为频繁（183次或77.8%），91次（38.7%）BSI发作发生在第1天至第30天。26%的发作导致住院，10%的病例死亡。只有自体HSCT对住院有保护作用。尽管在二元分析中，拔除中心静脉导管（CVC）和癌症多国支持治疗协会（MASCC）评分高达21分是死亡的保护因素，但只有MASCC仍然是保护因素。
