Raje N S, Rao S R, Iyer R S, Kelkar R S, Pai S K, Nair C N, Kurkure P A, Magrath I T, Advani S H
Department of Medical Oncology, Tata Memorial Hospital, Bombay, India.
Pediatr Hematol Oncol. 1994 May-Jun;11(3):271-80. doi: 10.3109/08880019409141670.
The use of empirical antibiotic combinations in the treatment of febrile neutropenic patients has decreased complication-related mortality in cancer patients. We have analyzed retrospectively 499 consecutive episodes of fever in 432 patients with acute lymphoblastic leukemia over a 5-year period. We have compared various antibiotic combinations used empirically in our study. Of the febrile episodes, 92% were neutropenic. The most common site of clinical documentation was the lung. The most common pathogen isolated in our setting was Pseudomonas aeruginosa (27.27%). The overall response rate to first-line empirical antibiotic combination was seen in 61.92%, the best results being with ceftazidime and amikacin combination (65.69%). A uniform antibiotic policy resulted in a decrease in mortality, with the number of deaths decreasing significantly in the 1989 to 1991 era (P = 0.00000003). The other contributing factors were an improvement in the supportive care with a reduction in length of hospital stay during induction. Our fungal isolates demonstrated 11 patients with documented fungal infection with a positive outcome in 8 patients.
在发热性中性粒细胞减少症患者的治疗中使用经验性抗生素联合用药已降低了癌症患者并发症相关的死亡率。我们回顾性分析了432例急性淋巴细胞白血病患者在5年期间连续出现的499次发热情况。我们比较了本研究中经验性使用的各种抗生素联合用药。在发热发作中，92%为中性粒细胞减少症。临床记录最常见的部位是肺部。我们研究中分离出的最常见病原体是铜绿假单胞菌（27.27%）。一线经验性抗生素联合用药的总体有效率为61.92%，头孢他啶和阿米卡星联合用药效果最佳（65.69%）。统一的抗生素政策降低了死亡率，在1989年至1991年期间死亡人数显著减少（P = 0.00000003）。其他促成因素是支持治疗得到改善，诱导期间住院时间缩短。我们的真菌分离结果显示，11例有记录的真菌感染患者中有8例预后良好。
