Vancomycin-resistant enterococci colonization and bacteremia in patients with hematological malignancies
Vancomycin-resistant enterococci colonization and bacteremia in patients with hematological malignancies
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DOI：
10.3855/jidc.4451
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发表时间：
2014-09-01
影响因子：
1.9
通讯作者：
Arabaci, Cigdem
中科院分区：
文献类型：
--
作者：
Gedik, Habip;Yildirmak, Taner;Arabaci, Cigdem
简介：我们回顾性评估了血液恶性肿瘤患者中万古霉素耐药肠球菌（VRE）定植率和VRE相关感染率。方法：土耳其伊斯坦布尔的一家拥有800张床位的三级医院--卫生部奥克梅卡尼培训和研究医院血液科的所有患者，在本回顾性研究中，对2010年11月至2012年11月期间年龄大于14岁且在血液系统癌症化疗期间发生发热性中性粒细胞减少症的患者进行了评价观察性研究。结果：共分析了126例符合纳入标准的患者中的282例血小板减少症发作。患者平均年龄为51.73 ± 14.4岁（范围：17 - 82岁），66例病例发生在男性患者中。恶性血液病患者的平均跨国癌症支持治疗协会评分为17.18 +/-8.27。50例（39.68%）患者被VRE定植，每例患者的平均VRE定植天数为34.27 +/-13.12天。只有两名患者发生了VRE菌血症：一名男性非霍奇金淋巴瘤患者在感染后存活，一名女性急性髓性白血病患者死于VRE菌血症。伴有VRE定植的血液恶性肿瘤患者在某些情况下预计会发生VRE或万古霉素敏感性肠球菌相关菌血症，包括严重粘膜炎、侵入性操作、以及使用密集的广谱抗生素，即使感染控制措施得到适当实施。
Introduction: We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies.Methodology: All patients in the hematology department of the Ministry of Health Okmeydani Training and Research Hospital, an 800-bed tertiary hospital in Istanbul, Turkey, older than 14 years of age and who developed febrile neutropenia during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated in this retrospective observational study.Results: A total of 282 neutropenic episodes in 126 patients who met the inclusion criteria were analyzed. The mean patient age was 51.73 +/- 14.4 years (range: 17-82 years), and 66 cases occurred in male patients. The mean Multinational Association for Supportive Care in Cancer score of patients with hematological malignancies was 17.18 +/- 8.27. Fifty (39.68%) patients were colonized with VRE, and the mean number of VRE colonization days per patient was 34.27 +/- 13.12 days. Only two patients developed VRE bacteremia: a male patient with non-Hodgkin's lymphoma who survived the infection, and a female patient with acute myeloid leukemia who died from VRE bacteremia.Conclusions: Patients with hematological malignancies accompanied by VRE colonization should be expected to develop VRE- or vancomycin-sensitive enterococci-related bacteremia under certain conditions, which include the development of severe mucositis, invasive procedures, and the use of intensive broad-spectrum antibiotics, even if infection control measures are implemented properly.