Singer C, Kaplan M H, Armstrong D
Am J Med. 1977 May;62(5):731-42. doi: 10.1016/0002-9343(77)90876-2.
During a 14 month period there were 364 episodes of bacteremia and fungemia at Memorial Sloan-Kettering Cancer Center. The first nine months of the study were retrospective, and the next five prospective. In patients with leukemia or lymphoma (group 1), Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus were the most frequently isolated organisms. The mortality in this group was 40.5 per cent. In the patients with solid tumor (group 2), Esch. coli, Staph. aureus, Bacteroides sp. and Candida sp. were most frequent. Mortality was 27.8 per cent. The source of infection in both groups was often indeterminate. High mortality was associated with pulmonary and intraabdominal infection and with Ps. aeruginosa, K. pneumoniae or polymicrobic sepsis. Factors of prognostic significance were the causative microorganism, source of infection and shock. Although mortality was higher in patients with leukopenia than in those with normal leukocyte counts, the differences were not significant. The mortality in this series was low considering the severity of the underlying diseases and the immunosuppressed state of many of the patients. In a prospective, randomly controlled study, mortality was further diminished by infectious disease consultation at the time the positive blood culture was reported. Severe fungal superinfection, predominantly aspergillosis and candidiasis, was found in 52 per cent of the autopsy patients with leukemia or lymphoma (group 1), but in only 8 per cent of those with solid tumors (group 2).
在14个月的时间里，纪念斯隆-凯特琳癌症中心共发生了364例菌血症和真菌血症。研究的前九个月为回顾性研究，后五个月为前瞻性研究。在白血病或淋巴瘤患者（第1组）中，大肠杆菌、铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌是最常分离出的病原体。该组的死亡率为40.5%。在实体瘤患者（第2组）中，大肠杆菌、金黄色葡萄球菌、拟杆菌属和念珠菌属最为常见。死亡率为27.8%。两组的感染源常常难以确定。高死亡率与肺部和腹腔内感染以及铜绿假单胞菌、肺炎克雷伯菌或多种微生物败血症相关。具有预后意义的因素是致病微生物、感染源和休克。虽然白细胞减少患者的死亡率高于白细胞计数正常的患者，但差异不显著。考虑到基础疾病的严重程度以及许多患者的免疫抑制状态，该系列研究中的死亡率较低。在一项前瞻性随机对照研究中，在报告血培养阳性时进行感染病会诊可进一步降低死亡率。在接受尸检的白血病或淋巴瘤患者（第1组）中，52%发现有严重的真菌二重感染，主要为曲霉菌病和念珠菌病，但在实体瘤患者（第2组）中仅为8%。
