Hjorth M, Weinfeld A, Brorson J E
Scand J Infect Dis. 1980;12(2):139-48. doi: 10.3109/inf.1980.12.issue-2.13.
29 episodes of suspected septicaemia in patients with acute leukemia were treated empirically with tobramycin 180--240 mg/day intravenously together with cephalothin 12 g/day. Patients without documented infection who did not respond to antibiotics and whose fever developed after a course of cytotoxic drugs, were given the provision of high dose corticosteroid therapy. Infection was documented microbiologically or clinically in 13/29 episodes. Septicaemia was proven in 7, and 6 had pneumonia. Neutropenia was present in 18/29 episodes. A satisfactory response to initial therapy was achieved in 7/13 with documented infection and in 9/16 without proven infection. The overall good response was 55%, 5/7 cases with septicaemia, but only 2/6 with pneumonia responded well. The 2 septicaemia patients who did not respond had Pseudomonas aeruginosa sepsis. In 16 episodes without documented infection 7 did not respond to initial therapy. To 4 of them, who were subject to recent cytotoxic drug administration, high dose corticosteroid therapy was given, and 3 of them responded well. Of the remaining 3 non-responders, one became afebrile after cytostatic and one after prednisolone treatment. Serum assays of tobramycin were done on the 1st and 5th day of therapy and no difference in concentration was observed on these 2 occasions. Five patients developed renal failure, but this was attributed to antibiotic therapy only in 1, who initially had an elevated serum creatinine. It is concluded, that in hospitals where pseudomonas is not a dominating pathogen, tobramycin--cephalothin may be a good combination to start empiric therapy with. In patients without proven infection, who have recently been subjected to cytotoxic therapy, and who do not respond to the initial course of antibiotics, a high dose of corticosteroids may be tried, provided the patient is monitored for the hazard of bacterial infection.
29例急性白血病患者疑似败血症，经验性给予静脉注射妥布霉素180 - 240mg/天，联合头孢噻吩12g/天。未记录到感染的患者，若对抗生素无反应且在接受一个疗程的细胞毒性药物治疗后出现发热，则给予大剂量皮质类固醇治疗。29例中有13例通过微生物学或临床确诊感染。7例确诊为败血症，6例患有肺炎。29例中有18例存在中性粒细胞减少。13例确诊感染患者中有7例对初始治疗反应良好，16例未确诊感染患者中有9例反应良好。总体良好反应率为55%，7例败血症患者中有5例反应良好，但6例肺炎患者中只有2例反应良好。2例无反应的败血症患者患有铜绿假单胞菌败血症。16例未确诊感染的病例中，7例对初始治疗无反应。其中4例近期接受过细胞毒性药物治疗，给予大剂量皮质类固醇治疗，3例反应良好。其余3例无反应者中，1例在接受细胞抑制剂治疗后退热，1例在接受泼尼松龙治疗后退热。在治疗的第1天和第5天进行了妥布霉素血清检测，这两个时间点的浓度无差异。5例患者出现肾衰竭，但只有1例最初血清肌酐升高的患者肾衰竭归因于抗生素治疗。结论是，在铜绿假单胞菌不是主要病原体的医院，妥布霉素 - 头孢噻吩可能是开始经验性治疗的良好组合。对于未确诊感染、近期接受过细胞毒性治疗且对初始抗生素疗程无反应的患者，可尝试给予大剂量皮质类固醇，但需对患者进行细菌感染风险监测。
