发热性中性粒细胞减少症患者的流行病学和感染源：一项十年纵向研究。
Epidemiology and source of infection in patients with febrile neutropenia: A ten-year longitudinal study.
机构信息
Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, Indiana, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Hospital Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
出版信息
J Infect Public Health. 2019 May-Jun;12(3):364-366. doi: 10.1016/j.jiph.2018.12.006. Epub 2018 Dec 26.
OBJECTIVES
No recent studies are available from Saudi Arabia on the etiology of febrile neutropenia. The objective of this study was to describe the characteristics of patients with febrile neutropenia and to calculate the rate of occurrence of bacteremia in these patients.
METHODS
This is a hospital-based study of patients admitted with febrile neutropenia from 2006 to 2015.
RESULTS
A total of 372 distinct episodes of febrile neutropenia representing 231 patients were included. Hematologic malignancies constituted 56.6% of the episodes. Positive blood cultures were reported in 13.5% with equal frequency of Gram-negative bacilli and gram positive cocci. The most commonly suspected sites of infection were blood 10.8% and pulmonary 9.2%, and the majority (72.5%) was thought to have no identifiable source of infection. Of all the episode, 32% had central venous catheters. The most frequently used single antimicrobial agents were imipenem (38%) and ceftazidime (7.5%). The mortality rate was 11.2% and it was significantly associated with the presence of bacteremia 24.4% versus 12.4% (P=0.016). Mortality was not significantly association with age, type of malignancy, presence of central venous catheter, or the severity of neutropenia. Compared to patients with hematological malignancy, patients with solid organ malignancy were more likely to be female 62% versus 14.9% (P<0.001) and were less likely to have bacteremia 8.7% versus 17.1%, P=0.042, respectively.
CONCLUSION
We had shown that febrile neutropenia in this study has a low rate of bacteremia and that about 45% received the recommended initial empiric therapy.
目的
沙特阿拉伯目前尚无关于发热性中性粒细胞减少症病因的研究。本研究的目的是描述发热性中性粒细胞减少症患者的特征，并计算这些患者中菌血症的发生率。
方法
这是一项基于医院的研究，纳入了 2006 年至 2015 年因发热性中性粒细胞减少症住院的患者。
结果
共纳入 372 例不同的发热性中性粒细胞减少症发作，涉及 231 例患者。血液系统恶性肿瘤占发作的 56.6%。阳性血培养的发生率为 13.5%，革兰氏阴性杆菌和革兰氏阳性球菌的发生率相等。最常怀疑的感染部位是血液 10.8%和肺部 9.2%，大多数（72.5%）认为没有明确的感染源。所有发作中，有 32%的患者有中心静脉导管。最常使用的单一抗菌药物是亚胺培南（38%）和头孢他啶（7.5%）。死亡率为 11.2%，与菌血症显著相关（24.4%比 12.4%，P=0.016）。死亡率与年龄、恶性肿瘤类型、中心静脉导管的存在或中性粒细胞减少症的严重程度无关。与血液系统恶性肿瘤患者相比，实体器官恶性肿瘤患者更可能为女性（62%比 14.9%，P<0.001），菌血症发生率更低（8.7%比 17.1%，P=0.042）。
结论
本研究表明，发热性中性粒细胞减少症的菌血症发生率较低，约 45%的患者接受了推荐的初始经验性治疗。
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