Carratalá J, Alcaide F, Fernández-Sevilla A, Corbella X, Lińares J, Gudiol F
Services of Infectious Disease, Ciutat Sanitària i Universitària de Bellvitge, University of Barcelona, Spain.
Clin Infect Dis. 1995 May;20(5):1169-73. doi: 10.1093/clinids/20.5.1169.
We prospectively studied 260 episodes of bacteremia that occurred over a 6-year period in neutropenic patients with cancer. Twenty-three episodes were caused by viridans streptococci. Thirteen (57%) of these strains were penicillin-resistant (MICs of penicillin ranged from 0.25 micrograms/mL to 8 micrograms/mL). Ten of the 13 penicillin-resistant strains (77%) were highly resistant to penicillin (MIC, > or = 4 micrograms/mL). Rates of bacteremia due to highly penicillin-resistant viridans streptococci increased significantly from zero episodes per 1,000 admissions in 1987 to 17 episodes per 1,000 admissions in 1992 (P = .003). In a comparison between penicillin-resistant and penicillin-susceptible viridans streptococci bacteremia, the administration of beta-lactam antibiotics during the previous 2 weeks was the only factor significantly associated with penicillin-resistant cases: 9 (69%) of 13 patients with penicillin-resistant bacteremia had received beta-lactams vs. 2 (20%) of 10 patients with penicillin-susceptible bacteremia (P = .036). These findings may have significant clinical implications in the choice of both antimicrobial prophylaxis and empirical antibiotic regimens.
我们前瞻性地研究了癌症中性粒细胞减少患者在6年期间发生的260例菌血症。23例由草绿色链球菌引起。其中13株（57%）对青霉素耐药（青霉素的最低抑菌浓度范围为0.25微克/毫升至8微克/毫升）。13株耐青霉素菌株中有10株（77%）对青霉素高度耐药（最低抑菌浓度≥4微克/毫升）。1987年每1000例住院患者中因对青霉素高度耐药的草绿色链球菌引起的菌血症发生率为零，到1992年每1000例住院患者中增至17例（P = 0.003）。在耐青霉素和对青霉素敏感的草绿色链球菌菌血症的比较中，前2周使用β-内酰胺类抗生素是与耐青霉素病例显著相关的唯一因素：13例耐青霉素菌血症患者中有9例（69%）接受过β-内酰胺类药物治疗，而10例对青霉素敏感菌血症患者中有2例（20%）接受过该治疗（P = 0.036）。这些发现可能对抗菌预防和经验性抗生素治疗方案的选择具有重要的临床意义。
