急性白血病病人化學治療後之嗜中性球低下併發燒的回溯性研究

Febrile Neutropenia in Patients with Acute Leukemia Following Chemotherapy: A Retrospective Review

裴松南(Sung-Nan Pei) ； 王銘崇(Ming-Chung Wang) ； 黃英彥(Eng-Yen Huang) ； 馬銘君(Ming-Chun Ma) ； 郭景元(Ching-Yuan Kuo)

《內科學誌》 17卷3期 (2006/06) Pp. 106-113

https://doi.org/10.6314/JIMT.2006.17(3).02

摘要

嗜中性球低下併發燒是癌症病人在化學治療後最重要的併發症，需即時的給予廣效性抗生素治療。我們針對急性白血病病人在接受化學治療後發生嗜中性球低下併發燒作回溯性研究，分析其感染部位、培養結果及對抗生素的反應。在13個月中共發生87次事件，常見感染的地方有口腔黏膜(40%)、不明部位(33%)及腸胃道(15%)。主要使用的抗生素為piperacillin，ceftazidime和cefepime併用或不併用aminoglycoside，三天內可退燒的比例依序為41%、35%、33%，並無統計學上的差別(p=0.80)。在87次發燒中有32次培養結果為陽性，陽性率為36.8%，培養出的菌種依次為革蘭氏陰性菌65.6%，革蘭氏陽性菌21.9%，黴菌9.4%；單一致病菌最多的是大腸桿菌有11次(34.4%)。因感染而死亡的病例有三例(3.4%)，其中兩例為血行黴菌感染。我們的研究顯示急性白血病病人化學治療後發生嗜中性球低下併發燒最常見的感染部位為口腔黏膜，感染菌種以革蘭氏陰性菌為主，對於目前常用的三種經驗性抗生素治療的成效在統計上沒有顯著差異。

關鍵字

嗜中性球低下併發燒 ； 急性白血病 ； 化學治療 ； 台彎

並列摘要

Febrile neutropenia is a common complication of cancer patients receiving chemotherapy. Empiric treatment with broad-spectrum parenteral antibiotics is important for high-risk patients. A retrospective study to evaluate the infection sources, pathogens and clinical responses of current recommended antibiotics were conducted in patients with acute leukemia complicated with febrile neutropenia. There were 87 episodes of febrile neutropenia related with chemotherapy during Aug. 2003 to Aug. 2004. Piperacillin-, ceftazidime- and cefepimebased antibiotics were the major choices in this study. The clinical response rates were 41%, 35% and 33% respectively, and there were no statistic significance. There were three mortalities (3.4%) and two shock episodes (2.3%). Among 87 episodes, there were 32 culture results (36.8%) including 30 septicemias, one bronchoalveolar lavage and one tissue culture. Gram-negative bacilli were predominant (65.6%) and Escherichia coli was the leading pathogen (34%). Seven gram-positive bacteremia episodes (21.9%) occurred without shock or mortality. Three candida species were isolated including two fatal Candida tropicalis candidemia and one invasive esophageal C. albicans. Our data showed that, for patients with febrile neutropenia in our hospital, there is no statistically significant difference in the response to piperacillin-, ceftazidime-, and cefepime-based empirical antibiotics regimens.

並列關鍵字

Febrile neutropenia ； Acute leukemia ； Chemotherapy ； Taiwan