Nováková I R, Donnelly J P, De Pauw B
Department of Internal Medicine, University Hospital St. Radboud, Nijmegen, The Netherlands.
Leuk Lymphoma. 1993 Aug;10(6):461-7. doi: 10.3109/10428199309148203.
Three hundred episodes of neutropenia were reviewed for the occurrence of potential sites of infection. Ninety sites (30 per cent) were identified at the onset of fever independent of initial bacteraemia which was encountered in 104 episodes (35%) and predominantly involved Gram-positive cocci. A further 90 sites were recorded involving mainly the lower respiratory tract (58%) and skin and soft tissue (18%). These changes evolved significantly later (mean of 5.1 and 4.3 days respectively) than did other foci which mainly presented at the onset of fever (p < 0.01). However the infectious aetiology was established in only 54 cases overall with fungi being responsible for 25 of 45 cases of lower respiratory tract infections with a known microbiological aetiology. The mortality associated with initial bacteraemia, focus at onset and unexplained fever was 11-14% while that associated with the development of a subsequent focus was 28% with lung infiltrates carrying the worst prognosis. Therefore rather than being seen as a final solution for possible infectious complications, empiric therapy provides an opportunity for daily review of the patient thereby increasing the likelihood of both explaining initial fever and diagnosing subsequent infection.
对300例中性粒细胞减少症发作病例进行了潜在感染部位发生情况的回顾。在发热开始时发现90个部位（30%），与104例（35%）出现的初始菌血症无关，初始菌血症主要涉及革兰氏阳性球菌。另外记录了90个部位，主要涉及下呼吸道（58%）和皮肤及软组织（18%）。这些变化比主要在发热开始时出现的其他病灶出现得明显更晚（分别平均为5.1天和4.3天，p<0.01）。然而，总体上仅在54例中确定了感染病因，在已知微生物病因的45例下呼吸道感染中，真菌导致了25例。与初始菌血症、发热开始时的病灶和不明原因发热相关的死亡率为11%-14%，而与随后病灶发展相关的死亡率为28%，肺部浸润的预后最差。因此，经验性治疗不应被视为可能的感染并发症的最终解决方案，而是为每日评估患者提供了机会，从而增加了解释初始发热和诊断后续感染的可能性。
