Engelhard D, Elishoov H, Strauss N, Naparstek E, Nagler A, Simhon A, Raveh D, Slavin S, Or R
Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel.
Transplantation. 1996 Feb 15;61(3):430-4. doi: 10.1097/00007890-199602150-00020.
The purpose of this study was to examine coagulase-negative staphylococcal infections in bone marrow transplantation (BMT) patients with central vein catheters by investigating incidence, clinical relevance, risk factors, methicillin resistance, clinical impact of initial empiric antimicrobial therapy without vancomycin, and management of documented catheter-related infections. A 5-year prospective study was conducted with daily evaluation of 242 BMT patients during hospitalization, including clinical assessment and blood culture via the Hickman/Broviac catheter. If fever or infected appearance occurred, peripheral blood cultures or exit site cultures, respectively, were done. Results showed a septicemia incidence of 7.0%, including in 6 patients following colonization, in 1 patient with tunnel infection, in 1 patient with thrombophlebitis, in 1 patient with exit site infection, and in 8 patients with septicemia of unknown origin. Total colonization incidence was 7%, with colonization only in 11 patients who had 16 episodes; incidence of exit site infection was 3.7%. Age > or = 18 years was the only identified risk factor for developing staphylococcal infection (P = 0.03). Despite a methicillin resistance rate of 45% and omission of vancomycin from the routine initial empiric antimicrobial regimen, the clinical course of coagulase-negative staphylococcal infections was relatively benign. A single patient, who experienced marrow rejection, died on day +31 with septicemia and only one patient experienced microbiological failure with recurrent colonization. Bacteria grown in both aerobic and anaerobic bottles were more likely true bacteremia than contaminant (P = 0.03). We conclude that the hazard of coagulase-negative staphylococcal infection does not mandate inclusion of a glycopeptide in the initial empiric antimicrobial regimen in BMT patients, even during febrile neutropenia. Hickman/Broviac-related staphylococcal infections, except for tunnel infection or thrombophlebitis, can usually be treated successfully without removing the catheter.
本研究的目的是通过调查凝固酶阴性葡萄球菌感染的发生率、临床相关性、危险因素、耐甲氧西林情况、初始经验性抗菌治疗不使用万古霉素的临床影响以及已记录的导管相关感染的管理，来研究接受骨髓移植（BMT）并使用中心静脉导管的患者中凝固酶阴性葡萄球菌感染情况。进行了一项为期5年的前瞻性研究，在住院期间每日对242例BMT患者进行评估，包括通过希克曼/布罗维阿克导管进行临床评估和血培养。如果出现发热或感染迹象，则分别进行外周血培养或出口部位培养。结果显示败血症发生率为7.0%，其中6例为定植后发生，1例为隧道感染，1例为血栓性静脉炎，1例为出口部位感染，8例为不明来源的败血症。总定植发生率为7%，仅11例患者发生定植，共16次发作；出口部位感染发生率为3.7%。年龄≥18岁是发生葡萄球菌感染的唯一确定危险因素（P = 0.03）。尽管耐甲氧西林率为45%，且常规初始经验性抗菌方案中未使用万古霉素，但凝固酶阴性葡萄球菌感染的临床过程相对良性。1例发生骨髓排斥的患者在+31天死于败血症，仅1例患者出现微生物学失败并反复定植。在需氧瓶和厌氧瓶中均生长的细菌比污染物更可能是真正的菌血症（P = 0.03）。我们得出结论，即使在发热性中性粒细胞减少期间，凝固酶阴性葡萄球菌感染的风险也不要求在BMT患者的初始经验性抗菌方案中加入糖肽类药物。除隧道感染或血栓性静脉炎外，与希克曼/布罗维阿克相关的葡萄球菌感染通常无需拔除导管即可成功治疗。
