当科血液悪性疾患患者における血流感染症の検討

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Objectives: This study was initiated to determine the local profile of bloodstream infections (BSIs) in patients with hematological malignancies. Particular attention was given to the characteristics of BSIs associated with death. Patients and Methods: 255 patients hospitalized in the adult hematology ward of Yamagata University Hospital for chemotherapy from January 2003 to December 2007 were studied retrospectively, and BSIs were identified. To examine the characteristics of BSIs associated with death, BSIs with onset within 21 days prior to patients' death were defined as critical BSIs and compared to non-critical BSIs. Results: A total of 119 BSIs were identified in 67 of 255 patients. Of 119 BSIs, 29 (24.3%) could be classified as critical BSIs. On logistic regression analysis, profound neutropenia (ANC=0 cells/μL) (OR=19.9; 95% CI=3.6 to 109.4; P<0.01) was the independent factor most associated with BSI onset. And Performance status 4 of the Eastern Cooperative Oncology Group criteria (bedridden status) (OR=20.1; 95% CI=4.4 to 91.0; P<0.01) was the independent factor most associated with critical BSI episodes. On univariate analysis, pneumonia and gastrointestinal disturbance were associated with critical BSI episodes. The pathogens were markedly different between critical and non-critical BSIs. The most common pathogens in critical BSIs were Enterococcus species (11 of 29; 37.9%), whereas Staphylococcus species were most common in noncritical BSIs (42 of 90; 46.7%). Conclusion: We determined the local profile of BSIs, and these data are useful for riskbased, empirical choosing of antimicrobial therapy in our ward. BSIs associated with death occur in patients with severe underlying conditions, so that non-antimicrobial supportive therapy needs to be implemented to improve BSI patients' survival.
2010-08-13

当科血液悪性疾患患者における血流感染症の検討

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