Venditti M, Tarasi A, Visco Comandini U, Gentile G, Girmenia C, Micozzi A, Martino P
Servizio Aggregato di Consulenze Infettivologiche, Università La Sapienza, Rome, Italy.
Eur J Clin Microbiol Infect Dis. 1993 Apr;12(4):241-7. doi: 10.1007/BF01967253.
Thirty-six cases of enterococcal septicemia in patients with hematological malignancies were reviewed retrospectively and categorized according to their clinical significance using strict previously described definitions. Overall, most of the infected patients were males (77%), had acute leukemia (64%), had recently received cytotoxic drug therapy (86%), were granulocytopenic at the onset of septicemia (77%), and acquired the infection during hospitalization (77%). The source of septicemia was unknown in 18 (50%) patients, intestinal in 15 (42%) and intravascular in three (8%). Mortality was 19% among 21 inpatients who had clinically significant septicemia and 30% among patients with septicemia of uncertain clinical significance. The fatal outcome could be definitively attributed to enterococcal septicemia in only one of the nine inpatients who died. Clinically significant septicemia appeared somewhat more frequently to be polymicrobial (p = 0.06), whereas septicemia of unknown significance presented more frequently as breakthrough septicemia (p = 0.013). Unless associated with intravascular infection, enterococcal septicemia in patients with hematological malignancies seems to represent a marker of cytotoxic drug damage of the intestinal mucosa rather than a truly invasive infection.
回顾性分析了36例血液系统恶性肿瘤患者的肠球菌败血症病例，并根据先前严格描述的定义按临床意义进行分类。总体而言，大多数感染患者为男性（77%），患有急性白血病（64%），近期接受过细胞毒性药物治疗（86%），败血症发作时粒细胞减少（77%），且在住院期间获得感染（77%）。18例（50%）患者的败血症来源不明，15例（42%）为肠道感染，3例（8%）为血管内感染。在21例具有临床意义的败血症住院患者中，死亡率为19%；在临床意义不明确的败血症患者中，死亡率为30%。在死亡的9例住院患者中，只有1例的死亡结局可明确归因于肠球菌败血症。具有临床意义的败血症似乎更常表现为多微生物感染（p = 0.06），而意义不明的败血症更常表现为突破性败血症（p = 0.013）。除非与血管内感染相关，血液系统恶性肿瘤患者的肠球菌败血症似乎代表了肠道黏膜细胞毒性药物损伤的一个标志，而非真正的侵袭性感染。
