Engelhard D, Elishoov H, Or R, Naparstek E, Nagler A, Strauss N, Cividalli G, Aker M, Ramu N, Simhon A
Department of Pediatrics, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel.
Bone Marrow Transplant. 1995 Oct;16(4):565-70.
The incidence and clinical course of nosocomial septicemia with Streptococcus viridans was evaluated prospectively in 242 consecutive bone marrow transplant (BMT) recipients throughout their 15-213 days' (median 47) hospitalization, including 4-58 days (median 18) of neutropenia. Initial empiric therapy for febrile neutropenia consisted of mezlocillin, gentamicin and cefazolin; glycopeptide was excluded. S. viridans septicemia occurred in 23/209 (11%) subjects with underlying malignant disease, and only during neutropenia with concomitant mucositis: in 20 subjects (four with ampicillin-resistant strains), S. viridans septicemia occurred at onset of febrile neutropenia, 1-5 days (median 4.5) post-BMT. All survived with an uncomplicated clinical course. Thus, glycopeptide seems unnecessary in the initial empiric antibiotic regimen. The other three subjects demonstrated S. viridans septicemia (two with ampicillin-resistant strains) on day 11 post-BMT; two died. The major risk identified was cytosine arabinoside administration in the conditioning regimen (P < 0.01).
对242例连续接受骨髓移植（BMT）的患者在其住院15 - 213天（中位数47天）期间，包括4 - 58天（中位数18天）的中性粒细胞减少期，对医院内草绿色链球菌败血症的发病率和临床病程进行了前瞻性评估。对发热性中性粒细胞减少症的初始经验性治疗包括美洛西林、庆大霉素和头孢唑林；未使用糖肽类药物。23/209例（11%）患有潜在恶性疾病的患者发生了草绿色链球菌败血症，且仅在中性粒细胞减少并伴有粘膜炎期间发生：20例患者（4例为耐氨苄西林菌株）在发热性中性粒细胞减少症发作时，即BMT后1 - 5天（中位数4.5天）发生了草绿色链球菌败血症。所有患者均存活，临床病程无并发症。因此，在初始经验性抗生素治疗方案中似乎不需要使用糖肽类药物。另外3例患者在BMT后第11天出现草绿色链球菌败血症（2例为耐氨苄西林菌株）；2例死亡。确定的主要风险是预处理方案中使用阿糖胞苷（P < 0.01）。
