González-Barca E, Fernández-Sevilla A, Carratalá J, Grañena A, Gudiol F
Service of Hematology, Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 1996 Apr;15(4):291-6. doi: 10.1007/BF01695660.
Trends in causative organisms and sources of infection were studied in a series of 288 episodes of bacteremia in neutropenic cancer patients observed in a single institution from 1986 to 1993. The incidence of bacteremia increased significantly from 20 episodes per 1000 admissions in 1986 to 50 episodes per 1000 admissions in 1993 (p = 0.00001). Over the study period, a continuous increment in gram-positive bacteremia, which reached 81% of episodes in 1993 (p = 0.000001), was observed. Conversely, the incidence of gram-negative bacteremia remained stable. Coagulase-negative staphylococci and viridans group streptococci were the most commonly isolated pathogens. Bacteremia caused by coagulase-negative staphylococci increased from 3 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.0001), and viridans group streptococci bacteremia increased from 0 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.000001). The upward trend in gram-positive bacteremia appeared to be related to a significant increase in both intravascular catheters (p = 0.003) and oral mucositis (p = 0.003) as sources of infection. Specific strategies to prevent chemotherapy-induced mucositis and catheter-related bacteremia merit further investigations.
1986年至1993年期间，在一家机构对288例中性粒细胞减少的癌症患者菌血症发作情况进行了研究，分析了致病微生物和感染源的趋势。菌血症的发病率从1986年每1000例入院患者中的20例显著增加到1993年的每1000例入院患者中的50例（p = 0.00001）。在研究期间，革兰氏阳性菌血症持续增加，1993年达到发作病例的81%（p = 0.000001）。相反，革兰氏阴性菌血症的发病率保持稳定。凝固酶阴性葡萄球菌和草绿色链球菌是最常分离出的病原体。凝固酶阴性葡萄球菌引起的菌血症从每1000例入院患者中的3例增加到每1000例入院患者中的19例（p = 0.0001），草绿色链球菌菌血症从每1000例入院患者中的0例增加到每1000例入院患者中的19例（p = 0.000001）。革兰氏阳性菌血症的上升趋势似乎与血管内导管（p = 0.003）和口腔黏膜炎（p = 0.003）作为感染源的显著增加有关。预防化疗引起的黏膜炎和导管相关菌血症的具体策略值得进一步研究。
