Wells C L, Ferrieri P, Weisdorf D J, Rhame F S
Department of Medicine, University of Minnesota, Minneapolis 55455.
Infect Control. 1987 Aug;8(8):317-9. doi: 10.1017/s0195941700066406.
The correlation of fecal gram-negative bacilli (GNB), neutropenia, and bacteremia was studied in 45 bone marrow transplant recipients. Weekly stool cultures were prospectively monitored for GNB resistant to routine prophylactic and empiric antimicrobial agents. Seven cases of GNB bacteremia occurred in 45 patients described as follows. Twenty-three patients had no fecal or blood GNB. Fifteen patients had fecal GNB and no blood GNB; three of these latter patients had less than or equal to 50/mm3 circulating white blood cells (WBC) at the time of isolation of fecal GNB but two of the three were concurrently receiving appropriate empiric antibiotics. Two patients had blood GNB but no fecal GNB: one patient had a trimethoprim/sulfamethoxazole (TMP-SMZ)-sensitive isolate that would not be detectable in the feces by our methodology and one patient had feces analyzed only after the bacteremic event. Five patients had fecal GNB and blood GNB: one of these patients did not have a fecal sample analyzed prior to bacteremia but the remaining four patients had the same species/antibiogram of GNB isolated from the feces two to three days prior to the detection of bacteremia. Thus, the fecal GNB could have been used to predict the antibiogram of the subsequent blood GNB. In addition, all four of these latter bacteremic patients had less than or equal to 50/mm3 circulating WBC at the time of documented fecal GNB. Thus, bone marrow transplant recipients with fecal GNB coupled with severe neutropenia (less than or equal to 50/mm3 circulating WBC) were more likely to develop bacteremia (P less than 0.02) than were those with fecal GNB and greater than 50/mm3 circulating WBC.
在45例骨髓移植受者中研究了粪便革兰氏阴性杆菌（GNB）、中性粒细胞减少和菌血症之间的相关性。前瞻性监测每周粪便培养物中对常规预防性和经验性抗菌药物耐药的GNB。45例患者中发生了7例GNB菌血症，情况如下。23例患者粪便和血液中均未检出GNB。15例患者粪便中有GNB但血液中未检出；后一组患者中有3例在粪便GNB分离时循环白细胞（WBC）计数≤50/mm³，但其中2例同时正在接受适当的经验性抗生素治疗。2例患者血液中有GNB但粪便中未检出：1例患者的分离株对甲氧苄啶/磺胺甲恶唑（TMP-SMZ）敏感，用我们的方法在粪便中无法检测到，另1例患者仅在菌血症事件发生后才对粪便进行分析。5例患者粪便和血液中均有GNB：其中1例患者在菌血症发生前未对粪便样本进行分析，但其余4例患者在菌血症检测前两到三天从粪便中分离出的GNB具有相同的菌种/抗菌谱。因此，粪便GNB可用于预测随后血液中GNB的抗菌谱。此外，在记录到粪便GNB时，这4例菌血症患者的循环WBC均≤50/mm³。因此，与粪便中有GNB且循环WBC＞50/mm³的患者相比，粪便中有GNB且伴有严重中性粒细胞减少（循环WBC≤50/mm³）的骨髓移植受者更易发生菌血症（P＜0.02）。
