Kanserli hastalarda bakteremi ve fungemi ile birlikteliği olan faktörler

Kanserli hastaların tedavisindeki birçok gelişmeye rağmen bakteriyel ve fungal infeksiyonlar en önemli mortalite nedenleridir. Bu çalışmada kanserli hastalarda bakteremi ve fungemi ile ilişkili faktörlerin belirlenmesi amaçlandı. Ocak 1996-Mayıs 1998 tarihleri arasında Hematoloji-Onkoloji servislerinde tedavi gören 71 hastada 54 (%52) nötropenik, 50 (%48) nötropenik olmayan toplam 104 febril epizot prospektif olarak değerlendirildi. Febril epizotların 22'sinde (%21) bakteremi veya fungemi saptandı. Bakteremi ve fungemi mevcudiyeti ile yaş, cins, infeksiyon odağı, altta yatan hastalık, diyare, nötrofil sayısı, böbrek veya karaciğer fonksiyon bozukluğu arasında ilişki bulunamadı. Mukozit tespit edilenlerde, santral venöz kateteri olanlarda ve trombosit sayısı 20 000/mm3'ten az olan hastalarda bakteremi veya fungemi tespit edilme olasılığı yüksek bulundu. On iki hasta febril epizot sırasında öldü. Dokuz vakanın ölüm nedeni infeksiyona, üç vakada ise kanama veya primer hastalığın diğer komplikasyonlarına bağlıydı (infeksiyona bağlı ölüm oranı % 8.7). Ölümün infeksiyon nedeniyle oluştuğu dokuz vakanın beşinden gram-negatif bakteriler sorumluydu. Sonuç olarak; kanserli hastalarda, mukozit, santral venöz kateter varlığı ve düşük trombosit sayısının bakteremi veya fungemi tespit edilme olasılığını arttırdığı, nötropeninin ise etkilemediği görüldü. Diğer taraftan kanserli hastalarda gram-negatif bakteriyel infeksiyonlarin mortalite nedenleri arasında ilk sırayı almaya devam ettiği tespit edildi.

Factors associated with bacteremia and fungemia in cancer patients

Although several advancements have been achieved in treatment of cancer patients, bacterial and fungal infections are still the most important cause öf mortality. In this study, we aimed to determine factors associated with bacteremia and fungemia in cancer patients. In 71 hospitalized patients with cancer who were admitted to Hematology-Oncology department between January 1996 and May 1998, 54 (52%) neutropenic and 50 (48%) nonneutropenic febrile episodes were evaluated. In 22 (21%) of the cases bacteremia or fungemia was present. There was no relation between bacteremia or fungemia and age, sex, neutrophil counts, focus of infection, underlying disease, diarrhea and renal or liver dysfunction. For the cancer patients having central venous catheter, severe mucositis and platelet count lower than 20 000/mm3, it was observed that the probability of fungemia or bacteremia was higher than the others. Twelve patients died during febrile episodes. The cause of death was related to infections in nine cases, and bleeding or other complications of theprimary disease in three cases (infection related mortality rate: 8.7%). Gram-negative bacteria were causative organisms in five of the nine patients who died from infection. In conclusion; we determined that muco-sitis, central venous catheterization, and low platelet count in cancer patients increased the probability of bacteremia or fungemia, while neutropenia did not have any effect on there. On the other hand, gram-negative bacterial infections have been found as the most important cause of mortality in cancer patients.

Kaynakça

1.Dinçol K. Kanser ve infeksiyon. Çalangu S, Eraksoy H,Özsüt H (editörler). İnfeksiyon Hastalıkları Kitabında. İs-tanbul: Yüce Yayınları, 1992:147-56.

2.Akalın HE. İmmünkompromize konakçıda fırsatçı man-tar infeksiyonları; epidemiyoloji ve önemi. Türkiye TıpDergisi 1994;3:189-92.

3.Koll BS, Brown AE. Changing patterns of infections inthe immunocompromised patient with cancer. In: PizzoPA(ed). Infectious complications in the immunocompro-mised host I: Hematol Oncol Clin North Am. Philadelp-hia: WB Saunders; 1993:753-69.

4.Ehni WF, Reller B, Ellison RT. Bacteremia in granulocy-topenic patients in a tertiary care general hospital. RevInfect Dis 1991;13:613-9.

5.Viscoli C, Bruzzi P, Castagnola E, et al. Factors associ-ated with bacteremia in febrile, granulocytopenic cancerpatients. Eur J Cancer 1994;30A:430-7.

6.Rintala E. Incidence and clinical significance of positiveblood cultures in febrile episodes of patients with hemato-logical malignancies. Scand J Infect Dis 1994;26:77-84.

7.From the Immunocompromised Host Society. The de-sign, analysis, and reporting of clinical trials on the em-pirical antibiotic management of the neutropenic patient.J Infect Dis 1990;161:397-401.

8.Gaya H, Klastersky J. Empirical therapy for bacterial in-fections in neutropenic patients. Turk J Haematol1998;15:3-15.

9.Freifeld AG, Pizzo PA, Walsh TJ. Infections in the can-cer patients. In: de Vita VT, Hellman S, Rosenberg SA,(eds). Cancer: Principles And Practice of Oncology. 5thedition, Philadelphia: Lippincot-Roven Publishers, 1997:2659-70

10. Nucci M, Spector N, Bueno AP, et al. Risk factors andattributable mortality associated with superinfections inneutropenic patients with cancer. Clin Infect Dis 1997;24:575-9.

11. Bodey GP. Fungal infection and fever of unknown originin neutropenic patients. Am J Med 1986;80 (suppl 5C):112-9.

12. Bodey GP. Infection in cancer patients. Am J Med 1986;81:11-26.

13. Peduzzi P, Shatney C, Sheagren J, Sprung C. Predictorsof bacteremia and gram-negative bacteremia in patientswith sepsis. The Veterans Affairs Systemic Sepsis Co-operative Study Group. Arch Intern Med 1992;152(3):529-35.

14. Spanik S, Kukuckova E, Pichna P, et al. Analysis of 553episodes of monomicrobial bacteremia in cancer pati-ents: Any association between risk factors and outcometo particular pathogen? Support Care Cancer 1997;5:330-3.

15. Gonzalez-Barca E, Fernandez-Sevilla A, Carratala J, etal. Prospective study of 288 episodes of bacteremia inneutropenic cancer patients in a single institution. Eur JClin Microbiol Infect Dis 1996;15(4):291-6.

16. Karabinis A, Hill C, Leclercq B, et al. Risk factors forcandidemia in cancer patients: A case-control study. JClin Microbiol 1988;26(3):429-32.

17. Pauw BED, Deresinski SC, Feld R, et al. Ceftazidimecompared with piperacilin and tobramycin for the empi-rical treatment of fever in neutropenic patients with can-cer. Ann Intern Med 1994;120:834-44.

18. Pizzo PA, Hathorn JW, Hiemenz J, et al. A randomizedtrial comparing ceftazidime alone with combination anti-biotic therapy in cancer patients with fever and neutro-penia. N Engl J Med 1986;315:552-8.

19. Cometta A, Calandra T, Gaya H, et al. Monotherapywith meropenem versus combination therapy with cefta-zidime plus amikacin as empiric therapy for fever in gra-nulocytopenic patients with cancer. Antimicrob AgentChemother 1996:1108-15.

20. Akova M, Ak A, Akalın E ve ark. Ateşli nötropenik has-talarda amikasin piperasilin ile ampirik antibiyotik tedavi-si. Hacettepe Tıp Dergisi 1989;22:137-49.

21. Brown AE. Neutropenia, fever, and infection. Am J Med1984;76:421-8.

22. Hathorn JW, Lyke K. Empirical treatment of febrile ne-utropenia; evolution of current therapeutic approaches.Clin Infect Dis 1997;24 (suppl 2):5256-65.

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