Hambleton J, Aragón T, Modin G, Northfelt D W, Sande M A
Department of Medicine, University of California, San Francisco 94143, USA.
Clin Infect Dis. 1995 Feb;20(2):363-71. doi: 10.1093/clinids/20.2.363.
We conducted a retrospective cohort study to evaluate the occurrence of bacteremia and associated mortality among hospitalized patients who were seropositive for the human immunodeficiency virus (HIV) and who developed fever and neutropenia following antineoplastic chemotherapy or for other reasons. Review of medical records revealed 224 episodes in 142 patients. Of these episodes, 57% occurred following antineoplastic chemotherapy, and 43% occurred under other circumstances. Members of the chemotherapy group had significantly less-advanced HIV disease, a lower mean absolute-neutrophil-count nadir, and a shorter duration of hospitalization. There was no difference between the two groups in the frequency of bacteremia or mortality due to all causes when they were compared by multivariate analysis. Statistically significant univariate and multivariate predictors of bacteremia included sepsis syndrome and concurrent infection. Predictors of mortality included sepsis syndrome, concurrent infection, bacteremia, and antimicrobial therapy. This study suggests that the cause of neutropenia in HIV-seropositive patients is not a predictor of the outcome of fever and neutropenic episodes. Instead, clinical presentation and concomitant illnesses have a greater impact on outcome for a patient.
我们进行了一项回顾性队列研究，以评估在接受抗肿瘤化疗后或因其他原因出现发热和中性粒细胞减少的人类免疫缺陷病毒（HIV）血清学阳性住院患者中菌血症的发生情况及相关死亡率。病历审查发现142例患者中有224次发作。在这些发作中，57%发生在抗肿瘤化疗后，43%发生在其他情况下。化疗组患者的HIV疾病进展程度明显较低，平均绝对中性粒细胞计数最低点较低，住院时间较短。通过多变量分析比较时，两组在菌血症频率或所有原因导致的死亡率方面没有差异。菌血症具有统计学意义的单变量和多变量预测因素包括脓毒症综合征和并发感染。死亡率的预测因素包括脓毒症综合征、并发感染、菌血症和抗菌治疗。这项研究表明，HIV血清学阳性患者中性粒细胞减少的原因不是发热和中性粒细胞减少发作结果的预测因素。相反，临床表现和伴随疾病对患者的结果影响更大。
