RISK-FACTORS FOR FUNGAL INFECTION IN PATIENTS WITH MALIGNANT HEMATOLOGIC DISORDERS - IMPLICATIONS FOR EMPIRICAL THERAPY AND PROPHYLAXIS
RISK-FACTORS FOR FUNGAL INFECTION IN PATIENTS WITH MALIGNANT HEMATOLOGIC DISORDERS - IMPLICATIONS FOR EMPIRICAL THERAPY AND PROPHYLAXIS
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DOI：
10.1093/clinids/18.4.525
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发表时间：
1994-04-01
影响因子：
11.8
通讯作者：
VANTWOUT, JW
中科院分区：
文献类型：
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作者：
GUIOT, HFL;FIBBE, WE;VANTWOUT, JW
为了确定哪些患者是播散性真菌感染的高危患者，应给予系统预防，我们研究了连续10年收治的341例恶性血液病患者的病历。这些患者代表了636名住院患者；在这些住院期间，发生了60例侵袭性真菌感染，44例死亡。所有死于这些感染的患者要么持续粒细胞减少，基础疾病预后不良，要么患有慢性移植物抗宿主病。58例没有或低水平的念珠菌定植的患者中有2例发生了播散性念珠菌感染，而23例高度定植的患者中有8例发生了这种感染(P<；.001)。在10名念珠菌感染的患者中，有9名在念珠菌感染前一周内有微生物证实的菌血症。骨髓移植后，10名慢性移植物抗宿主病患者中有8名患者发生了致命的曲霉菌感染，而36名非慢性移植物抗宿主病患者中有2名患者没有发生这种疾病(P<；.001)。我们的研究结果表明，接受微生物菌血症治疗的高水平念珠菌定植患者和慢性移植物抗宿主病患者可能受益于系统的抗真菌预防。
To determine which patients are at high risk for disseminated fungal infection and should be given systemic prophylaxis, we studied the charts of 341 patients with malignant hematologic disorders who were admitted to our institution during 10 consecutive years. These patients represented 636 admissions; during these admissions, 60 invasive fungal infections occurred, with deaths in 44 cases. All patients who died of these infections either had persisting granulocytopenia and a poor prognosis for the underlying disease or suffered from chronic graft-vs.-host disease. Two of 58 patients who had no or low-level candidal colonization developed disseminated candidal infection whereas eight of 23 with high-level colonization developed this infection (P < .001). Nine of the 10 patients with candidal infection had microbiologically proven bacteremia within the week preceding the candidal infection. After bone marrow transplantation, 8 of 10 patients with chronic graft-vs.-host disease vs. 2 of 36 without this disease (P < .001) developed fatal infection with Aspergillus species. The results of our study reveal that patients with high-level candidal colonization who were treated for microbiologically proven bacteremia and patients with chronic graft-vs.-host disease might benefit from systemic antifungal prophylaxis.