BACTEREMIA DUE TO VIRIDANS STREPTOCOCCUS IN NEUTROPENIC PATIENTS WITH CANCER - CLINICAL SPECTRUM AND RISK-FACTORS
BACTEREMIA DUE TO VIRIDANS STREPTOCOCCUS IN NEUTROPENIC PATIENTS WITH CANCER - CLINICAL SPECTRUM AND RISK-FACTORS
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DOI：
10.1093/clinids/18.1.25
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发表时间：
1994-01-01
影响因子：
11.8
通讯作者：
FRANCIOLI, P
中科院分区：
文献类型：
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作者：
BOCHUD, PY;EGGIMAN, P;FRANCIOLI, P
在1988年至1991年期间，25例因恶性血液病接受强化化疗的贫血患者发生了26次草绿色链球菌引起的菌血症。10例患者出现与菌血症相关的并发症：单侧肺浸润（4例）、急性呼吸窘迫综合征（ARDS）（4例）、低血压（3例）和心内膜炎（2例）。所有ARDS患者均接受高剂量阿糖胞苷治疗，并因缓症链球菌引起菌血症。3例患者（12%）死亡，但仅1例可能与菌血症相关。将接受喹诺酮类预防治疗的病例患者与接受类似预防治疗但未发生草绿色链球菌菌血症的对照组患者进行比较。诱发因素的多变量分析显示，高剂量阿糖胞苷（P = .01）、粘膜炎（P = .02）和既往无肠外抗生素治疗（P = .01）是草绿色链球菌菌血症发生的独立危险因素。在研究期间接受喹诺酮预防的259例患者中，22例（8.5%）发生草绿色链球菌菌血症，而接受喹诺酮和青霉素的82例患者发生3次（3.7%）（P = 0.07）。然而，后三次发作是由对青霉素敏感性降低的菌株引起的，因此表明对青霉素的耐药性可能会限制这种抗生素在未来作为预防剂的使用。
Between 1988 and 1991, 26 episodes of bacteremia due to viridans streptococci occurred in 25 neutropenic patients undergoing intensive chemotherapy for hematologic malignancies. Complications related to the bacteremia were observed in 10 episodes: unilateral pulmonary infiltrates (4), acute respiratory distress syndrome (ARDS) (4), hypotension (3), and endocarditis (2). All patients with ARDS had received high doses of cytosine arabinoside and had bacteremia due to Streptococcus mitis. Death occurred in three patients (12%) but was possibly related to bacteremia in only one case. Case patients who had received prophylaxis with quinolones were compared with matched control patients who received similar prophylaxis but who did not have bacteremia due to viridans streptococci. Multivariate analysis of predisposing factors showed that high doses of cytosine arabinoside (P = .01), the presence of mucositis (P = .02), and the absence of previous therapy with parenteral antibiotics (P = .01) were independent risk factors for the development of viridans streptococcal bacteremia. Of 259 patients who had received quinolone prophylaxis during the study period, 22 (8.5%) developed an episode of viridans streptococcal bacteremia as compared with three episodes (3.7%) in 82 patients who had received a quinolone and penicillin (P = .07). However, the latter three episodes were caused by strains with decreased susceptibility to penicillin, thus suggesting that resistance to penicillin might limit the use of this antibiotic as a prophylactic agent in the future.