Donnelly J P, Muus P, Horrevorts A M, Sauerwein R W, De Pauw B E
Department of Haematology, University Hospital, Nijmegen, The Netherlands.
Scand J Infect Dis. 1993;25(1):43-50. doi: 10.1080/00365549309169668.
33 consecutive allogeneic bone marrow transplant recipients who were likely to develop streptococcal bacteraemia were treated for 5 days with clindamycin (900 mg i.v. t.d.s) and ceftazidime (2 g t.d.s.) for the initial management of fever associated with severe oral mucositis. Bacteraemia due to 'viridans' streptococci was encountered in 23 cases (70%) as mucositis progressed to peak severity and occurred a day before fever in 8 cases. At the end of treatment with clindamycin only 2 patients had defervesced although the streptococci were successfully eradicated. C-reactive protein (CRP) levels continued to rise in 18 cases and declined by more than 10% in only 7 cases. Severe oromucositis rather than infection appeared to induce an acute phase response with fever suggesting bacteraemia due to 'viridans' streptococci to have been a consequence of mucosal damage. Indeed, oromucositis was the only primary focus of inflammation in 22 patients and only after its resolution did both fever and CRP levels diminish. By then, patients had also begun to recover from granulocytopenia. These data indicate that rather than including a specific antimicrobial like clindamycin in an empirical regimen, it would be more beneficial to evolve strategies that minimise mucosal damage in this patient population.
33例可能发生链球菌菌血症的异基因骨髓移植受者，因严重口腔黏膜炎伴发热接受初始治疗，给予克林霉素（静脉注射900mg，每日3次）和头孢他啶（每日3次，每次2g）治疗5天。随着黏膜炎进展至严重程度峰值，23例（70%）出现了由“草绿色”链球菌引起的菌血症，其中8例在发热前一天发生。仅用克林霉素治疗结束时，尽管链球菌已被成功根除，但只有2例患者退热。18例患者的C反应蛋白（CRP）水平持续升高，仅7例下降超过10%。严重的口腔黏膜炎而非感染似乎引发了伴有发热的急性期反应，提示“草绿色”链球菌引起的菌血症是黏膜损伤的结果。事实上，22例患者中口腔黏膜炎是唯一的主要炎症病灶，只有在其消退后，发热和CRP水平才会降低。到那时，患者也已开始从粒细胞减少症中恢复。这些数据表明，在经验性治疗方案中，与其加入像克林霉素这样的特定抗菌药物，制定能使该患者群体黏膜损伤最小化的策略可能更有益。
