Bacteremia after hematopoietic stem cell transplantation:: incidence and predictive value of surveillance cultures
Bacteremia after hematopoietic stem cell transplantation:: incidence and predictive value of surveillance cultures
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DOI：
10.1038/sj.bmt.1704414
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发表时间：
2004-04-01
影响因子：
4.8
通讯作者：
Beguin, Y
中科院分区：
文献类型：
--
作者：
Frère, P;Hermanne, JP;Beguin, Y
我们研究了 1982 年至 2001 年间进行的 622 例移植手术，目的是：(1) 确定菌血症的发生率、发生时间和病因，以及 (2) 检查常规监测培养物预测菌血症的能力。 248 名患者共发生 404 次发作（每位患者 0.65 次），原因为凝固酶阴性葡萄球菌 ( n = 171, 42%)、革兰氏阴性菌 ( n = 129, 32%)、链球菌 ( n = 48, 12%)、其他革兰氏阳性菌 ( n = 33, 8%)、厌氧菌 ( n = 9, 2%) 和真菌 ( n = 14, 3%)。与自体移植 (0.44) 相比，同种异体移植 (0.96 次/患者) 菌血症更常见 (P < 0.0001)。总体发病率从 1990 年之前的 0.92 次/患者下降到 1991 - 1996 年的 0.66 次和 1997 - 2001 年的 0.55 (P < 0.0001)，但这仅在自体移植中观察到。其中，212例（53%）发生在出院前，192例（47%）发生在出院后。与其他药物相比，凝固酶阴性葡萄球菌、其他革兰氏阳性菌和革兰氏阴性菌的比例较低（P = 0.001）。在 50% 的病例中，引起菌血症的病原体曾存在于之前的常规监测培养物中。结论：（1）菌血症仍然是一种常见的并发症，特别是在同种异体移植中，甚至在出院后很长时间； (2) 常规监测培养可以预测 50% 病例的菌血症，但鉴于成本，这种观察的实际影响有限。
We studied 622 transplants undertaken between 1982 and 2001 to: ( 1) determine the incidence, timing and etiology of bacteremias, and ( 2) examine the ability of routine surveillance cultures to predict bacteremias. A total of 404 episodes ( 0.65 episode per patient) occurred in 248 patients, due to coagulase- negative staphylococci ( n = 171, 42%), Gram- negative bacteria ( n = 129, 32%), streptococci ( n = 48, 12%), other Gram- positive bacteria ( n = 33, 8%), anaerobes ( n = 9, 2%) and fungi ( n = 14, 3%). Bacteremias were more frequent in allogeneic ( 0.96 episode/ patient) compared to autologous ( 0.44) transplants ( P < 0.0001). The overall incidence decreased from 0.92 episode/ patient until 1990 to 0.66 in 1991 - 1996 and 0.55 in 1997 - 2001 ( P < 0.0001), but this was only observed in autologous transplants. Among them, 212 ( 53%) occurred before hospital discharge and 192 ( 47%) thereafter. This proportion was lower for coagulase-negative staphylococci, other Gram- positive bacteria and Gram- negative bacteria compared to other agents ( P = 0.001). In 50% of the cases, the agent responsible for the bacteremic episode was present in routine surveillance cultures previously. In conclusion: ( 1) bacteremias remain a frequent complication, particularly in allogeneic transplantation, even long after hospital discharge; ( 2) routine surveillance cultures can predict bacteremias in 50% of the cases, but the practical impact of this observation is limited in view of the costs.