Cohen J, Donnelly J P, Worsley A M, Catovsky D, Goldman J M, Galton D A
Lancet. 1983;2(8365-66):1452-4. doi: 10.1016/s0140-6736(83)90799-7.
10 neutropenic leukaemic patients had septicaemia caused by viridans streptococci, organisms not commonly recognised as opportunist pathogens. 1 patient died; in the remainder recovery was generally dependent on an adequate circulating granulocyte count (seven patients) rather than specific antimicrobial therapy. Seven of the infections were caused by Streptococcus mitis, and seven of the eight strains tested were resistant to cotrimoxazole, which the patients had received as prophylaxis against infection. It is suggested that oral ulceration caused by cytotoxic chemotherapy provided a portal of entry for cotrimoxazole-resistant viridans streptococci. The increasing incidence of infections with gram-positive organisms as a complication of neutropenia prompts a reconsideration of current empirical antimicrobial therapy.
10名中性粒细胞减少的白血病患者发生了由草绿色链球菌引起的败血症，这类微生物通常不被视为机会性病原体。1例患者死亡；其余患者的康复通常取决于足够的循环粒细胞计数（7例患者），而非特异性抗菌治疗。7例感染由缓症链球菌引起，所检测的8株菌株中有7株对复方新诺明耐药，而这些患者此前一直服用复方新诺明预防感染。提示细胞毒性化疗引起的口腔溃疡为耐复方新诺明的草绿色链球菌提供了侵入途径。革兰氏阳性菌感染作为中性粒细胞减少的并发症，其发生率不断增加，这促使人们重新审视当前的经验性抗菌治疗。
