Yuen K Y, Woo P C, Hui C H, Luk W K, Chen F E, Lie A K, Liang R
Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Bone Marrow Transplant. 1998 Jun;21(11):1137-43. doi: 10.1038/sj.bmt.1701246.
A study of the risk factors associated with bacteraemia in 191 allogeneic bone marrow transplant (BMT) recipients (1991-1996) was performed. In contrast to risk factors commonly cited for cancer chemotherapy, mucositis, degree of conditioning toxicity of the gut and lungs, duration of neutropenia, and severity of neutropenia and monocytopenia were not associated with bacteraemia in the pre-engraftment period, during which the only significant risk factor was late stage underlying disease (P < 0.05). After engraftment, Hickman catheter infection, and severe acute and chronic graft-versus-host disease (GVHD) were found to be independently associated with bacteraemia by multivariate analysis (P < 0.001, <0.05 and <0.05, respectively). This might be explained by intense antimicrobial prophylaxis, early empirical treatment, and non-routine use of haemopoietic growth factors. No significant difference in mortality was detected between bacteraemic and non-bacteraemic patients in both periods. Allogeneic BMT recipients are therefore a group of patients distinct from other cancer patients receiving chemotherapy at risk of developing bacteraemia. The study findings prompt consideration of a management protocol incorporating early and routine use of haemopoietic growth factors before engraftment in high-risk patients with late stage underlying malignancies, routine antimicrobial prophylaxis for acute GVHD with intense immunosuppression, and intravenous immunoglobulin therapy for chronic GVHD. Further cost-benefit analyses are warranted.
对191例异基因骨髓移植（BMT）受者（1991 - 1996年）发生菌血症的相关危险因素进行了研究。与癌症化疗通常提及的危险因素不同，黏膜炎、肠道和肺部预处理毒性程度、中性粒细胞减少持续时间以及中性粒细胞减少和单核细胞减少的严重程度在植入前期与菌血症无关，在此期间唯一显著的危险因素是晚期基础疾病（P < 0.05）。植入后，通过多变量分析发现希克曼导管感染以及严重的急性和慢性移植物抗宿主病（GVHD）与菌血症独立相关（分别为P < 0.001、<0.05和<0.05）。这可能是由于强化抗菌预防、早期经验性治疗以及造血生长因子的非常规使用所致。在这两个时期，菌血症患者和非菌血症患者的死亡率均未检测到显著差异。因此，异基因BMT受者是一组与其他接受化疗有发生菌血症风险的癌症患者不同的患者群体。该研究结果促使人们考虑一种管理方案，该方案包括在植入前对晚期基础恶性肿瘤的高危患者早期和常规使用造血生长因子，对伴有强烈免疫抑制的急性GVHD进行常规抗菌预防，以及对慢性GVHD进行静脉注射免疫球蛋白治疗。有必要进行进一步的成本效益分析。
