Figuera A, Tomás J F, Hernández L, Jiménez M L, Peñarrubia M J, del Rey M C, Arranz R, Cámara R, López-Lorenzo J L, Fernández-Rañada J M
Servicio de Hematología, Hospital Universitario de La Princesa, Madrid.
Rev Clin Esp. 1996 Aug;196(8):515-22.
The results of empiric antibiotic therapy in 126 episodes of febrile neutropenia in patients with hematologic neoplasms postchemotherapy and bone marrow transplantation are presented. The main objective of this work was the study of the initial control of infection comparing two glycopeptidic antibiotics: vancomycin and teicoplanin combined with imipenem in first line of empiric therapy. The secondary objective was to analyze the overall control of infection during the complete episode of neutropenia using a sequential empiric antibiotic therapy course which included the addition of amikacin followed by intravenous amphotericin B when fever persisted or recurred without microbiological documentation. Both initial courses (no guidelines), imipenem + vancomycin (arm A) and imipenem + teicoplanin (arm B) resulted in a similar percentage of response at 72 hours, both in episodes of fever of unknown origin (FUO) (55% and 68%, respectively; p = NS) and in those microbiologically documented (54% and 34.5%, p = NS); 58% and 79% of these episodes, respectively, were caused by gram-positive organisms. About 60% of patients in both arm ultimately required the empiric addition of amikacin, with or without amphotericin B, because of persistence or recurrence of fever; the percentage of overall responses in both arm did not differ significantly, both in FUO (70% and 86%, p = NS) and in microbiologically documented episodes (71% and 45%, p = NS). The overall infectious mortality for the whole group was 1.58%. In conclusion, no significant differences were observed in the clinical response or in toxicity between the combination of imipenem with any of the two glycopeptides: vancomycin or teicoplanin, for the initial empiric therapy of febrile neutropenia. The sequential empiric use of amikacin followed by amphotericin B assured an adequate overall control of infection in a group of patients with prolonged severe neutropenia.
本文呈现了血液系统肿瘤患者化疗及骨髓移植后126例发热性中性粒细胞减少症患者经验性抗生素治疗的结果。这项研究的主要目的是比较两种糖肽类抗生素（万古霉素和替考拉宁）联合亚胺培南作为经验性治疗一线用药时对感染的初始控制情况。次要目的是通过序贯经验性抗生素治疗疗程分析中性粒细胞减少症整个病程中感染的总体控制情况，该疗程包括在发热持续或复发且无微生物学依据时加用阿米卡星，随后静脉使用两性霉素B。两个初始疗程（无指南），即亚胺培南+万古霉素（A组）和亚胺培南+替考拉宁（B组），在72小时时的反应率相似，无论是不明原因发热（FUO）发作（分别为55%和68%；p=无显著性差异）还是微生物学确诊的发作（分别为54%和34.5%，p=无显著性差异）；这些发作中分别有58%和79%由革兰氏阳性菌引起。两组中约60%的患者最终因发热持续或复发而需要经验性加用阿米卡星，无论是否加用两性霉素B；两组在FUO（分别为70%和86%，p=无显著性差异）和微生物学确诊发作（分别为71%和45%，p=无显著性差异）中的总体反应率无显著差异。整个组的总体感染死亡率为1.58%。总之，对于发热性中性粒细胞减少症的初始经验性治疗，亚胺培南与两种糖肽类药物（万古霉素或替考拉宁）中的任何一种联合使用在临床反应或毒性方面均未观察到显著差异。序贯经验性使用阿米卡星随后使用两性霉素B确保了一组严重中性粒细胞减少症持续时间较长的患者感染得到充分的总体控制。
