Summary
The frequency, etiology and risk factors of superinfections during and/or within one week after antibiotic therapy with betalactam-aminoglycoside combinations were evaluated in 631 patients with hematologic malignancies admitted to the Institute of Hematology of Rome from January 1982 to December 1984. 356 patients (56%) developed 402 episodes of proven or presumed infection. Of these patients, 78 developed 102 superinfections. Overall, superinfections responded less satisfactorily to antibiotic therapy than the primary febrile episodes (63% vs. 85%). The distribution of etiologic agents of superinfections differed from those responsible for primary infections, since fungi and anaerobes (especiallyClostridium difficile) were mostly isolated after antibiotic therapy had begun. Moreover, among aerobic bacteria, frequently antibiotic-resistant species, such asPseudomonas aeruginosa, Streptococcus faecalis andStaphylococcus epidermidis were the leading etiologic agents of superinfection. The risk of superinfection appeared to increase with the depth and persistence of granulocytopenia. On the other hand, the length of hospitalization, length of previous antibiotic therapy, previous chemoprophylaxis and presence of indwelling venous catheter did not affect the risk of superinfection.
Zusammenfassung
Bei 631 Patienten mit malignen hämatologischen Erkrankungen, die von Januar 1982 bis Dezember 1984 am hämatologischen Institut Rom zur Behandlung kamen, wurde eine Auswertung bezüglich der Häufigkeit, Ursache und der Risikofaktoren von Superinfektionen während und/oder innerhalb einer Woche nach Behandlung mit Betalactam-Aminoglykosid-Kombinationen vorgenommen. Bei 356 Patienten (56%) traten 402 Episoden einer erwiesenen oder vermuteten Infektion auf. 78 dieser Patienten bekamen 102 Episoden von Superinfektionen. Insgesamt sprachen Superinfektionen weniger befriedigend auf die Antibiotika-Therapie an als die primären febrilen Episoden (63% gegenüber 85%). Die Verteilung der kausalen Erreger der Superinfektionen war gegenüber den primären Infektionen verschieden; Pilze und Anaerobier (vor allemClostridium difficile) wurden vorwiegend nach Beginn der Antibiotika-Therapie isoliert. Unter den aeroben Erregern waren häufig Antibiotika-resistente Spezies wiePseudomonas aeruginosa, Streptococcus faecalis undStaphylococcus epidermidis die führenden kausalen Erreger von Superinfektionen. Das Risiko für eine Superinfektion schien mit dem Grad und der Dauer der Granulozytopenie zuzunehmen. Die Dauer der stationären Behandlung, Dauer einer vorausgegangenen Antibiotikatherapie, frühere Chemoprophylaxe und Anwesenheit eines intravenösen Verweilkatheters hatte hingegen keinen Einfluß auf das Risiko für eine Superinfektion.
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Serra, P., Santini, C., Venditti, M. et al. Superinfections during antimicrobial treatment with betalactam-aminoglycoside combinations in neutropenic patients with hematologic malignancies. Infection 13 (Suppl 1), S115–S122 (1985). https://doi.org/10.1007/BF01644231
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DOI: https://doi.org/10.1007/BF01644231