FEVER IN THE PEDIATRIC AND YOUNG-ADULT PATIENT WITH CANCER - A PROSPECTIVE-STUDY OF 1001 EPISODES
FEVER IN THE PEDIATRIC AND YOUNG-ADULT PATIENT WITH CANCER - A PROSPECTIVE-STUDY OF 1001 EPISODES
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DOI：
10.1097/00005792-198205000-00003
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发表时间：
1982-01-01
期刊：
影响因子：
1.6
通讯作者：
COMMERS, JR
中科院分区：
文献类型：
--
作者：
PIZZO, PA;ROBICHAUD, KJ;COMMERS, JR
细胞毒性化疗提高了癌症患者的生存率，但也增加了严重感染并发症的风险。为了确定合理的抗生素治疗和预防框架，在5年的研究期间，对324例患者的1001次发热发作进行了前瞻性评估。潜在的恶性肿瘤包括白血病（40.5%）、淋巴瘤（17%）和实体瘤（42.5%），患者年龄从1-49岁（平均15.7岁）。39.8%接受细胞毒性化疗的患者出现发热。一旦发热（F+）（定义为口腔温度bbb38度）。温度在24小时内升高3次或升高38.5度。C)，对患者进行评估，然后根据是否粒细胞减少（G+）（定义为< 500多形核白细胞mm3）进行分层。在F+发作中，20.8%发生在非粒细胞减少的患者中，其中只有17.3%与感染有关。至少75%的F+G+发作是由明确或隐匿性感染引起的。在51.8%的病例中，可以在最初或7天的随访评估期内诊断出感染病因。呼吸道或血流感染占所有记录感染的62.5%，所有微生物学定义的感染中85%是由细菌引起的。白血病、淋巴瘤或实体瘤患者的感染类型或感染性生物没有差异，这表明一旦粒细胞减少，这些患者发生严重感染的风险相当。在793例F+G+病例中，有48.2%的病例无法初步确定感染性病因。其中，55.5%与1周内粒细胞恢复有关，这些低风险不明原因发热（FUO）发作均与随后的感染并发症无关。然而，在经典性治疗7天后停用抗生素的高危FUO发作（即G+ bbb7天）中，有一半发生了感染性并发症，这表明未被发现的感染对慢性粒细胞减少患者很重要。为了描述可能区分严重感染（如菌血症）与非严重感染（如低风险FUO）患者的特征，对140例严重感染患者的历史和临床特征进行了全面比较；没有任何一种特征能够持续可靠地预测感染。因此，就目前而言，无论其潜在的恶性肿瘤或临床表现如何，对于任何出现发热的G+患者，开始使用经经验抗生素仍然是必要的。
Cytotoxic chemotherapy has improved the survival of cancer patients but has also increased the risk for serious infectious complications. To define a rational framework for antibiotic therapy and prophylaxis, prospective evaluations were made of 1001 febrile episodes in 324 patients during a 5 yr study period. The underlying malignancies included leukemia (40.5%), lymphoma (17%) and solid tumors (42.5%) in patients ranging in age from 1-49 yr (mean, 15.7). Fever occurred in 39.8% of patients receiving cytotoxic chemotherapy. Once febrile (F+) (defined as an oral temperature > 38.degree. C 3 times over a 24-h period or as a single temperature spike > 38.5.degree. C), patients were evaluated and then stratified according to whether they were granulocytopenic (G+) (defined as < 500 polymorphonuclear leukocytes mm3). Of the F+ episodes, 20.8% occurred when patients were nongranulocytopenic, of which only 17.3% were associated with infection. At least 75% of the F+G+ episodes were due to a defined or occult infection. In 51.8% of these, an infectious etiology could be diagnosed initially or within a 7-day follow-up evaluation period. Infections of the respiratory tract or blood stream accounted for 62.5% of all documented infections, and 85% of all microbiologically-defined infections were due to bacteria. There was no difference in the types of infections or infectious organisms in patients with leukemia, lymphoma or solid tumors, suggesting that once granulocytopenic, these patients share a comparable risk for serious infections. An infectious etiology could not be initially defined in 48.2% of the 793 F+G+ episodes. Of these, 55.5% were associated with granulocyte recovery within 1 wk and none of these low-risk fever of unknown origin (FUO) episodes were associated with subsequent infectious complications. However, infectious complications occurred in half of the high-risk FUO episodes (i.e., G+ > 7 days) when antibiotics were discontinued after 7 days of empiric therapy, suggesting that undetected infections are important in patients with protracted granulocytopenia. To delineate features which might differentiate patients with serious infections (e.g., bacteremias) from those without (e.g., low-risk FUO), historical and clinical features of 140 such patients were comprehensively compared; no one feature was consistently and reliably predictive of infection. Hence, for the present, regardless of their underlying malignancy or clinical presentation, initiation of empiric antibiotics in any G+ patient who becomes febrile continues to be necessary.