Love L J, Schimpff S C, Schiffer C A, Wiernik P H
Am J Med. 1980 May;68(5):643-8. doi: 10.1016/0002-9343(80)90243-0.
The grave prognosis associated with gram-negative bacteremia occurring in granulocytopenic patients with cancer suggests that granulocyte transfusions are frequently indicated. We have evaluated 67 episodes of gram-negative bacteremia, studied in four consecutive antibiotic trials, in order to correlate prognostic determinants of recovery. These patients had a median absolute granulocyte count of 100/microliter at the time of bacteremia. Empiric antibiotic regimens were begun at the first evidence of suspected infection. Granulocyte transfusions were employed only as clinically indicated by inadequate patient response to antibiotic therapy. Among the 29 patients who had an increase in their granulocyte count of greater than or equal to 100/microliter over the subsequent 14 days, 27 (93 per cent) recovered whereas among 38 patients who had no appreciable increase in their granulocyte count, 21 (55 per cent) improved (p = 0.006). In this latter group of patients with no granulocyte recovery, the susceptibility of the pathogen(s) to the initial empiric antibiotic regimen was of major importance. None of four patients responded when the pathogen was resistant to both antibiotics initially utilized, six of 14 (44 per cent) patients responded when there was susceptibility to one antibiotic, and 15 of 20 (75 per cent) patients responded when there was susceptibility to both antibiotics (p less than 0.025). We conclude that patients with gram-negative bacteremia and persistent granulocytopenia will often respond to antimicrobial therapy alone provided the initial choice of empiric antibiotics is appropriate and that their use is instituted promptly. Granulocyte transfusions need not be added unless clinical evaluation indicates inadequate response.
癌症粒细胞减少患者发生革兰氏阴性菌血症，其预后严峻，这表明经常需要输注粒细胞。我们评估了连续四项抗生素试验中研究的67例革兰氏阴性菌血症病例，以关联恢复的预后决定因素。这些患者菌血症发生时的绝对粒细胞计数中位数为100/微升。一旦出现疑似感染的首个证据，即开始经验性抗生素治疗方案。仅在患者对抗生素治疗反应不佳的临床指征下才使用粒细胞输注。在随后14天内粒细胞计数增加大于或等于100/微升的29例患者中，27例（93%）康复；而在粒细胞计数无明显增加的38例患者中，21例（55%）病情改善（p = 0.006）。在这组粒细胞未恢复的患者中，病原体对初始经验性抗生素治疗方案的敏感性至关重要。当初始使用的两种抗生素对病原体均耐药时，4例患者无一有反应；当对一种抗生素敏感时，14例患者中有6例（44%）有反应；当对两种抗生素均敏感时，20例患者中有15例（75%）有反应（p＜0.025）。我们得出结论，革兰氏阴性菌血症且持续粒细胞减少的患者，只要初始选择的经验性抗生素合适且及时使用，往往仅对抗菌治疗有反应。除非临床评估表明反应不佳，否则无需添加粒细胞输注。
