Invasive fungal infections in neutropenic enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients
Invasive fungal infections in neutropenic enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients
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DOI：
10.1186/1471-2334-6-35
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发表时间：
2006-02-26
影响因子：
3.7
通讯作者：
Glasmacher, A
中科院分区：
文献类型：
--
作者：
Gorschluter, M;Mey, U;Glasmacher, A
背景：中性粒细胞减少性小肠结肠炎是急性白血病强化化疗后最常见的危及生命的并发症。革兰氏阴性菌构成致病病原体的最重要的组。真菌也有报道，但其实际意义仍不清楚。该指南不解决具体的治疗建议真菌性血小板减少性小肠结肠炎。方法：在这里，我们进行了荟萃分析，以回答问题：什么是真菌性血小板减少性小肠结肠炎的频率和死亡率？致病真菌的频率和微生物学分布是否支持经验性抗真菌治疗？报道的真菌性贫血性小肠结肠炎的抗真菌治疗结果是否有助于选择合适的药物？经过系统的搜索，我们提取和总结了所有的详细数据从完整的literature.Results：在186篇文章中描述的患者与血小板减少性小肠结肠炎，我们发现29份报告描述了53例致病真菌病原体。我们没有发现关于抗真菌治疗作用的随机对照试验，没有高质量的队列研究，也没有高质量的病例对照研究。根据所有860例报告的患者计算的真菌性血小板减少性小肠结肠炎的合并频率为6.2%，仅根据选定的代表性研究计算的合并频率为3.4%。在94%的患者中，念珠菌属。参与其中合并死亡率为81.8%。大多数作者没有报告或进行抗真菌therapy.Conclusion：在血小板减少性小肠结肠炎患者中，真菌病原体发挥相关作用，但与细菌相比是次要作用。关于治疗的证据非常少，但本研究的流行病学数据可能为选择经验性抗真菌治疗提供有用的线索。
Background: Neutropenic enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal neutropenic enterocolitis.Methods: Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal neutropenic enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal neutropenic enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature.Results: Among 186 articles describing patients with neutropenic enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal neutropenic enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy.Conclusion: In patients with neutropenic enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in neutropenic enterocolitis.