Wade J C, Schimpff S C, Newman K A, Wiernik P H
Ann Intern Med. 1982 Oct;97(4):503-8. doi: 10.7326/0003-4819-97-4-503.
Staphylococcus epidermidis, a major component of the skin flora, is usually considered a contaminant when recovered from diagnostic cultures. Since 1974 infections caused by gram-negative bacilli and S. aureus occurring among patients with granulocytopenic cancer have remained constant; infections due to S. epidermidis occurring before 1977 at a rate of 2.0 per 1000 days of hospitalization of patients with acute leukemia, increased to 14.6 per 1000 days in 1979. All S. epidermidis infections before 1977 originated from skin sites; since 1977 the respiratory tract and alimentary canal have become the predominant sites of origin. Predisposing factors for infection were profound granulocytopenia (less than 100/microL), a diagnosis of acute leukemia, and an oral nonabsorbable antibiotic regimen lacking vancomycin. The increased incidence of infection was not related to a nosocomial source or the more frequent use of long-term indwelling catheters. Methicillin resistance among isolates was common (40%). Intravenous vancomycin therapy provided the best therapeutic results. Diagnostic cultures positive for S. epidermidis in the setting of infection and profound granulocytopenia warrant appropriate antibiotic therapy.
表皮葡萄球菌是皮肤菌群的主要组成部分，从诊断性培养物中分离出来时通常被视为污染物。自1974年以来，粒细胞减少性癌症患者中由革兰氏阴性杆菌和金黄色葡萄球菌引起的感染一直保持稳定；1977年以前，急性白血病患者中表皮葡萄球菌感染的发生率为每1000住院日2.0例，到1979年增至每1000住院日14.6例。1977年以前所有表皮葡萄球菌感染均起源于皮肤部位；自1977年以来，呼吸道和消化道已成为主要的起源部位。感染的易感因素包括严重粒细胞减少（低于100/微升）、急性白血病诊断以及缺乏万古霉素的口服不可吸收抗生素治疗方案。感染发生率的增加与医院感染源或长期留置导管的更频繁使用无关。分离株中耐甲氧西林很常见（40%）。静脉注射万古霉素治疗提供了最佳治疗效果。在感染和严重粒细胞减少的情况下，表皮葡萄球菌诊断性培养阳性需要进行适当的抗生素治疗。
