Ranchere J Y, Gordiani B, Bachmann P
Cancer Center Léon Bérard, Lyon, France.
Support Care Cancer. 1995 Nov;3(6):409-13. doi: 10.1007/BF00364981.
Immunodeficiency secondary to cancer chemotherapy (chemotherapy for less than 3 months, or intensive chemotherapy with bone marrow transplant) may be responsible for postoperative infections. To estimate the value of this hypothesis, a prospective study was done over a period of 18 months in patients who had undergone pulmonary surgery. Antibiotic prophylaxis was by pefloxacin, one tablet (400 mg) 1 h before surgery then 11 h after. Clinical examination, a chest X-ray and blood cell count were carried out every day for 10 days and on the 15th day. All the drain-tips were cultured. In a case of infection, samples were obtained and cultured. One group comprised 22 immunodeficient patients (group A), and 33 patients (group B) had received no prior chemotherapy (bone-marrow transplantation = 36.7%). There were differences between the two groups in age (A:33.5 +/- 12.3 years; B:50.8 +/- 18.4 years), and type of tumour (A: metastasis = 95.5%; B: lung cancer = 51.5%). Surgical operation was bilateral for 36.4% of the patients in group A. There was more anatomical resection (pneumonectomy and lobectomy) in group B. Lung function did not differ between the two groups (abnormalities: A = 54.6%; B = 63.6%). In group A, there were 3 pulmonary infections (13.7%), but in group B 10 infections (30.3%) with 9 pulmonary infections (4 with bacteraemia) and 1 wound infection. The bacteriological finding showed two pathogens in 7 cases and no bacteriological isolates in 2 cases. With broad-spectrum antibiotherapy all the patients were cured except 1. There was one postoperative death in group B. This patient died of respiratory distress after pneumonectomy complicated by pneumonia and septicaemia (Streptococcus pneumoniae) in the remaining lung. Surgical procedures are performed with increasing frequency on patients with immunocompromised status. Classically the risk of infection is more important for these patients. In this study prior cancer chemotherapy or bone marrow transplantation did not seem to be an aggravating factor of the risk of infection. But further methodological analysis would not allow us to distinguish between a real impact of chemotherapy and the influence of group heterogeneity.
癌症化疗继发的免疫缺陷（化疗时间少于3个月，或进行骨髓移植的强化化疗）可能是术后感染的原因。为评估这一假说的价值，对接受肺部手术的患者进行了为期18个月的前瞻性研究。预防性使用抗生素为培氟沙星，术前1小时服用1片（400毫克），术后11小时再服1片。术后10天内每天进行临床检查、胸部X光检查和血细胞计数，并在第15天进行检查。对所有引流管尖端进行培养。发生感染时，采集样本并进行培养。一组包括22名免疫缺陷患者（A组），33名患者（B组）未接受过化疗（骨髓移植占36.7%）。两组在年龄（A组：33.5±12.3岁；B组：50.8±18.4岁）和肿瘤类型（A组：转移瘤占95.5%；B组：肺癌占51.5%）方面存在差异。A组36.4%的患者进行了双侧手术。B组进行了更多的解剖性切除（肺切除术和肺叶切除术）。两组肺功能无差异（异常情况：A组=54.6%；B组=63.6%）。A组有3例肺部感染（13.7%），但B组有10例感染（30.3%），其中9例肺部感染（4例伴有菌血症）和1例伤口感染。细菌学检查结果显示，7例有两种病原体，2例未分离出细菌。除1例患者外，所有患者经广谱抗生素治疗后均治愈。B组有1例术后死亡。该患者在肺切除术后死于呼吸窘迫，并发剩余肺叶的肺炎和败血症（肺炎链球菌）。免疫功能低下患者接受手术的频率越来越高。传统上，这些患者感染风险更高。在本研究中，既往癌症化疗或骨髓移植似乎并非感染风险的加重因素。但进一步的方法学分析无法让我们区分化疗的实际影响和组间异质性的影响。
