Finello Malena, Suasnabar David Francisco, García Mercedes de Jesús, Díaz María Victoria, Richetta Luis, Toranzo Agustín, Hernández Daniela, Cometto María Aldana, Vázquez Sofía Mariela, Caeiro Juan Pablo, Sierra Jeremías, Saad Emanuel José
Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
Servicio de Hematología y Oncología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
Rev Argent Microbiol. 2021 Jul-Sep;53(3):183-193. doi: 10.1016/j.ram.2020.11.001. Epub 2020 Dec 30.
Bloodstream infections (BI) are relevant in neutropenic patients because they are associated with an increased number of complications and death. The objective was determinate the epidemiologic and microbiologic features of the BI in neutropenic patients with solid neoplasm (SN) and hematologic neoplasm (HN). Retrospective study in two third level hospitals between 2009 and 2016. They were included all the patients older than 18 years-old with active oncologic disease and neutropenia, who had BI. Patients with dermatologic cancer other than melanoma where excluded. A total of 143 BI in neutropenic were observed, of which 80.4% occurred in HN. Around 97.9% of the patients had a high-risk neutropenia without differences between both groups. The most frequent site of BI was primary bacteremia (46.9%) and catheter-associated infection (21%), without significant differences between the two groups. The gram negatives bacilli (GNB) predominated over the gram positive cocci (GPC) and they represented 74.1% of the isolated bacteria, being Escherichia coli the most frequent (32.8%). Among the gram positive cocci, Staphylococcus aureus (28.1%) was the most frequent isolated, followed by coagulase-negative Staphylococci (CNS). There were no differences in microbiological isolates between both groups. With regard to the antimicrobial susceptibility 67.5% of the CNS, 17.6% of the E. coli and 27.6% of the Klebsiella pneumoniae were multiresistant with no differences between both groups. Only 11.1% of S. aureus isolates were methicillin resistant. In conclusion BI of the neutropenic patients where most frequents within patients with HN, GNB were the main microbiological isolates. High mortality was observed in neutropenic patients with BI.
血流感染（BI）在中性粒细胞减少患者中较为常见，因为它们与并发症数量增加和死亡相关。目的是确定实体瘤（SN）和血液系统肿瘤（HN）中性粒细胞减少患者中BI的流行病学和微生物学特征。对2009年至2016年间两家三级医院进行回顾性研究。纳入所有年龄大于18岁、患有活动性肿瘤疾病且中性粒细胞减少并发生BI的患者。排除黑色素瘤以外的皮肤癌患者。共观察到143例中性粒细胞减少患者发生BI，其中80.4%发生在HN患者中。约97.9%的患者存在高危中性粒细胞减少，两组之间无差异。BI最常见的部位是原发性菌血症（46.9%）和导管相关感染（21%），两组之间无显著差异。革兰氏阴性杆菌（GNB）多于革兰氏阳性球菌（GPC），它们占分离细菌的74.1%，其中大肠埃希菌最常见（32.8%）。在革兰氏阳性球菌中，金黄色葡萄球菌（28.1%）是最常见的分离菌，其次是凝固酶阴性葡萄球菌（CNS）。两组之间微生物分离株无差异。关于抗菌药物敏感性，67.5%的CNS、17.6%的大肠埃希菌和27.6%的肺炎克雷伯菌对多种药物耐药，两组之间无差异。仅11.1%的金黄色葡萄球菌分离株对甲氧西林耐药。总之，中性粒细胞减少患者的BI在HN患者中最为常见，GNB是主要的微生物分离株。观察到中性粒细胞减少合并BI的患者死亡率较高。
