Burke P J, Braine H G, Rathbun H K, Owens A H
Johns Hopkins Med J. 1976 Jul;139(1):1-12.
In order to optimize the clinical management of fever in acute myelocytic leukemia (AML), our experience with febrile patients during two therapy periods was reviewed. A structured approach to the management of fever was then devised and evaluated during a third period. Among a total of 104 patients with AML, 77 were febrile at presentation. Only agranulocytic patients (15%) had severe infection, while 43% had localized sites which responded to specific antibiotic therapy. The remainder (42%) had fever functionally attributed to leukemia. In contrast, life-threatening infection occurred in most patients (90%) after antileukemic treatment was begun. During the trial therapy period, the empiric use of carbenicillin-gentamicin for fever greater than or equal to 101 degree F during aplasia reduced the incidence of sepsis from 90 to 30% and of bacteremia from 50 to 23%. The fall in the incidence of blood and localized site cultures positive for Pseudomonas aeruginosa from 65 to 15% corresponded to a reduction in the number of distinct organisms per site from 1.6 to 1.0. These data suggest that hematogenously born invasion of infected sites by endogenous organisms has been prevented. Aplastic patients with fever responded to therapy by defervescing (54%) or improving clinically (34%). Stopping antibiotics once started while evaluating persistent fever was detrimental. Although the early empiric use of amphotericin B reduced the incidence of fungemia, its proper use in fever management is yet to be determined.
为了优化急性髓细胞白血病（AML）发热的临床管理，我们回顾了两个治疗阶段中发热患者的情况。然后在第三个阶段设计并评估了一种针对发热管理的结构化方法。在总共104例AML患者中，77例在就诊时发热。仅粒细胞缺乏患者（15%）发生严重感染，而43%有局部病灶，对特定抗生素治疗有反应。其余患者（42%）的发热在功能上归因于白血病。相比之下，在开始抗白血病治疗后，大多数患者（90%）发生了危及生命的感染。在试验治疗阶段，对于再生障碍性贫血期间体温≥101华氏度的发热患者经验性使用羧苄西林-庆大霉素，使败血症的发生率从90%降至30%，菌血症的发生率从50%降至23%。铜绿假单胞菌血培养和局部病灶培养阳性率从65%降至15%，相应地每个病灶中不同生物体的数量从1.6个降至1.0个。这些数据表明，内源性生物体通过血行途径侵袭感染部位的情况已得到预防。再生障碍性贫血发热患者对治疗有反应，体温下降（54%）或临床症状改善（34%）。在评估持续发热时一旦开始使用抗生素就停用是有害的。尽管早期经验性使用两性霉素B降低了真菌血症的发生率，但其在发热管理中的合理应用尚待确定。
