单一头孢吡肟经验性治疗急性白血病低危粒细胞缺乏感染临床研究

Efficacy and safety of cefepime monotherapy in the empirical treatment of febrile neutropenia under acute leukemia

目的:回顾性评估单一头孢吡肟经验性治疗急性白血病低危粒细胞缺乏(粒缺)发热的疗效。方法:急性白血病住院患者发生低危粒缺感染的155例次入选研究,其中男95例次,女60例次,年龄19～72岁,中位年龄38岁。低危的判断标准参考美国感染病学会(IDSA)标准并结合我院实际情况所制定的12条标准,治疗方法为头孢吡肟2g加入生理盐水250ml中,每日2次,静脉点滴。结果:在入选的155例次感染事件中,128例次(82.6%)临床好转,27例次(17.4%)临床无好转,没有患者发生死亡。41例患者(26.4%)可获得细菌学资料,共检出52例次。检出的菌株中革兰阳性菌为20例次(38.5%),革兰阴性菌为32例次(61.5%)。在这41例患者中,35例(85.4%)获得痊愈,6例(14.6%)评判为无效,3例菌血症患者分别在治疗11、13和14d后症状、体征完全正常,细菌培养转阴。无严重不良事件发生。结论:单一头孢吡肟经验性治疗急性白血病低危粒缺感染具有较好的疗效和安全性。

Objective To evaluate the efficacy of the empirical cefepime monotherapy in the treatment of acute leukemia with low risk neutropenic fever. Methods One hundred and fiftyfive patients were included in this study, including 95 males and 60 females with the median age of 38 years （19-72 years）. The judgement of low risk was according to the Infectious Diseases Society of America （IDSA） criteria and the practical status of our hospital. The empirical treatment consisted of cefepime 2 g diluted by normal saline, twice a day, intravenously. Results One hundred and twenty eight out of 155 patients （82.6%） responded to the treatment without death. The microbial data were available in 41 patients （26.4%）, and 52 strains were isolated. In the 52 strains, 20 were proved Gram positive （38.5%） and 32 Gram negative （61.5%）. Thirty- five out of 41 patients （85.4%） recovered from the infection, and 6 patients （14.6%） had no response to the treatment. Three patients with bacteremia reached clinical and biological response on days 11,13 and 14 after the treatment, respectively. No serious adverse events occurred. Conclusions Cefepime monotherapy is effective and safe in the treatment of low risk neutropenic fever under acute leukemia.