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中华重症医学电子杂志 ›› 2016, Vol. 02 ›› Issue (03) : 171 -174. doi: 10.3877/cma.j.jssn.2096-1537.2016.03.007

所属专题: 重症医学 文献

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免疫功能抑制患者的血行性感染:临床处理有何不同?
杜斌   
  • 收稿日期:2016-07-11 出版日期:2016-08-28
  • 通信作者: 杜斌
  • 基金资助:
    首都特色临床应用研究专项基金(Z131107002213112)

Management of bloodstream infection in immunocompromised patients

Bin Du   

  • Received:2016-07-11 Published:2016-08-28
  • Corresponding author: Bin Du
  • About author:
    Corresponding author: Du Bin, Email:
引用本文:

杜斌. 免疫功能抑制患者的血行性感染:临床处理有何不同?[J/OL]. 中华重症医学电子杂志, 2016, 02(03): 171-174.

Bin Du. Management of bloodstream infection in immunocompromised patients[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(03): 171-174.

血行性感染是免疫功能抑制患者最常见的感染性并发症之一,罹患率和致死率很高。革兰阴性杆菌(尤其多重耐药革兰阴性杆菌)是最常见的致病微生物。由于免疫功能抑制患者炎症反应减弱,血行性感染的临床表现缺乏特异度,往往需要结合生物标志物进行综合判断。免疫功能抑制患者发生血行性感染后,其抗生素治疗疗程应适当延长。

Bloodstream infection (BSI) is one of the major infectious complications in immunocompromised patients, leading to high morbidity and mortality. Gram-negative bacilli, especially those multi-resistant strains are the most common pathogens seen in this cohort of patients. Due to the insufficient inflammatory response, there is a lack of specific clinical manifestations of BSI in immunocompromised patients and therefore identification of biomarkers is required to help clinical diagnosis. A prolonged duration of antibiotic therapy should be considered in immunocompromised patients with BSI.

表1 免疫功能抑制的定义
表2 MASCC风险模型:根据患者出现发热时的表现给予相应分数*
[1]
Gustinetti G, Mikulska M. Bloodstream infections in neutropenic cancer patients: a practical update[J]. Virulence, 2016, 7(3):280–97.
[2]
Lo Menzo S, la Martire G, Ceccarelli G, et al. New insights on epidemiology and management of bacterial bloodstream infection in patients with hematological malignancies[J]. Mediterr J Hematol Infect Dis, 2015, 7(1):e2015044.
[3]
Kulkarni AP. Immunocompromised hosts: infections and biomarkers[J]. South Asian J Cancer, 2013, 2(4):209–210.
[4]
De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definition of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) consensus group[J]. Clin Infect Dis, 2008, 46(12):1813–1821.
[5]
Williams MD, Braun LA, Cooper LM, et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care[J]. Crit Care, 2004, 8(5):R291–R298.
[6]
Gudiol C, Bodro M, Simonetti A, et al. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients[J]. Clin Microbiol Infect, 2013, 19(5):474–479.
[7]
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2011, 52(4):427–431.
[8]
Herbers AH, de Haan AF, van der Velden WJ, et al. Mucositis not neutropenia determines bacteremia among hematopoietic stem cell transplant recipients[J]. Transpl Infect Dis, 2014, 16(2):279–285.
[9]
Bouza E, Burillo A, Guembe M. Managing intravascular catheter-related infections in heart transplant patients: how far can we apply IDSA guidelines for immunocompromised patients[J]. Curr Opin Infect Dis, 2011, 24(4):302–308.
[10]
Cordonnier C, Buzyn A, Leverger G, et al. Epidemiology and risk factors for Gram-positive coccal infections in neutropenia: toward a more targeted antibiotic strategy[J]. Clin Infect Dis, 2003, 36(2):149–158.
[11]
Klastersky J, Paesmans M, Rubenstein EB, et al. The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients[J]. J Clin Oncol, 2000, 18(16):3038–3051.
[12]
Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis[J]. Lancet Infect Dis, 2013, 13(5):426–435.
[13]
Paolucci M, Stanzani M, Medlchlonda F, et al. Routine use of a real-time polymerase chain reaction method for detection of bloodstream infections in neutropaenic patients[J]. Diagn Microbiol Infect Dis, 2013, 75(2):130–134.
[14]
Tissari P, Zumla A, Tarkka E, et al. Accurate and rapid identification of bacterial species from positive blood cultures with a DNA-based microarray platform: an observational study[J]. Lancet, 2010, 375(9710):224–230.
[15]
Vincent JL, Brealey D, Libert N, et al. Rapid diagnosis of infection in the critically ill: a multicenter study of molecular detection in bloodstream infections, pneumonia, and sterile site infections[J]. Crit Care Med, 2015, 43(11):2283–2291.
[16]
Varani S, Stanzani M, Paolucci M, et al. Diagnosis of bloodstream infections in immunocompromised patients by real-time PCR[J]. J Infect, 2009, 58(5):346–351.
[17]
Paul M, Dickstein Y, Borok S, et al. Empirical antibiotics targeting Gram-positive bacteria for the treatment of febrile neutropenic patients with cancer[J]. Cochrane Database Syst Rev, 2014, 14(1):CD003914.
[18]
Averbuch D, Orasch C, Cordonnier C, et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia[J]. Haematologica, 2013, 98(12):1826–1835.
[19]
Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2009, 49(1):1–45.
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