1436

Staphylococcus

aureus

Bacteremia

in Patients

with

Hematologic

Disorders

Hisashi FUNADA, Hiroshi YONEYAMA,Toshihiko MACHI and Tamotsu MATSUDA TheProtectedEnvironment UnitandThirdDepartment ofMedicine, Kanazawa University SchoolofMedicine, Kanazawa 920,Japan (Received: May11,1992) (Accepted: July14,1992) Key words: methicillin-resistant Staphylococcusaureus (MRSA), bacteremia, hematologic malignancy, surveillance cultures, vancomycin

Abstract During with

the

20-year

mainly

acute

upper

unit.

and

MRSA

respiratory

neutropenia.

tract

cultures.

Among all

materially

between

in 30%

of all

four

with

with

lymphoma

the

two

MRSA

often

with

MSSA

6% of (MSSA)

preceded

primary the

received

. Prolonged

lesions

Most of

MSSA

of bacteremia years . The skin

episodes

occurred

bacteremia

was

, including disorders

hematologic

. Antibiotic

mostly

detected

foci,

chiefly

abbreviated

located

in the

therapy,

therefore

therapy

is

10 , in

a

and

during therapy

in admission

, 19 (86%) survived longer than vancomycin . The survival rate did

antibiotic

, although

bacteremia with

all 433 episodes in the last four

development

. Secondary

bacteremia

patients

foci .

whereas bacteremia

who

26

aureus

, representing strains common

bacteremias

metastatic

Staphylococcus in

monomicrobial

S. aureus

of

documented

hospitalization,

bacteremia

and

evident

most

during with

MRSA

patients

patients

cancer

were

patients

episodes

were

methicillin-sensitive

acquisition

22

including

malignant

colonization

to MRSA

27

(MRSA),

replaced

Pharyngeal

predisposed

1972-1991,

strains

leukemia

hematology

in

period,

methicillin-resistant

lung,

one

week,

not were

differ found

, seems

warranted

in

neutropenic

proposed

patients.

Introduction Since

the

resistant already as

one

early

occurred of

the

major

gram-positive

clinical

significance

experience

with

Department

of by

MRSA

cocci7,

27

and

episodes

S.

in

aureus

We

a few

bacteremia

University

methicillin-sensitive

by

years with

little units

counterparts

and

cancer

, especially epidermidis

study

has

, as

been

those and

had

ranked

concerning our at

between

-

with acute enterococci

reports

disorders

a comparison

methicillin

Japan1)

available

present hematologic

on

with in

. S. aureus

information

. The

, focusing (MSSA) .

infection frequency

earlier2)

Staphylococcus

complicating

Hospital

severe

increasing

patients

, relatively hematology

Materials Patients

States

outnumbered

however

and with

neutropenic

bacteremia of

colonization reported

United

been is,

Kanazawa

been

the in

has

8). There

MRSA

Medicine, and

it

of

have

of bacteremia recently

of

outbreaks

(MRSA)

Australia

causes

although

among

hospital

aureus

in Europe,

leukemia3)•`7),

caused

1980s,

Staphylococcus

the 20-year

the

Third

bacteremias

Methods

studied reviewed

the

別刷 請 求 先:(〒920)金

case

records

of

all

patients

with

hematologic

disorders

who

developed

S . aureus

沢 古 宝 町13番1号

金 沢 大 学 医学 部 附 属病 院 高 密 度無 菌 治 療 部

舟田

久 感 染 症 学 雑誌

第66巻

第10号

S. aureus bacteremia acute

at

the

leukemia,

department

chronic

thrombocytopenic All

were

patients

with

whether

to this

Since

a

rule,

Surveillance

1437

The

hematologic

myeloma,

diseases

aplastic

anemia

included

and

idiopathic

patients

long-term

(a

who

to

cefmetazole

MRSA

wash

their

as

bacteremia

and

most

for

nutrition

such

switched

thereafter

rooms

as

have

study

private

contact

to

such

(a carbapenem) the

in

. Infecand an

carboxypenicillins,

during in

used

ureidopenicillins,

imipenem

patient

and

been

antibiotic

cases

, and

cared

after

often

plactam and

used

were

before

a

were

. Physicians

has

parenteral

cefazolin,

and

floor

access and

, were in latamoxef

and

, amikacin

hands

venous

with

cephem)

frequently

hospital

products

, such to 1981

1972

40-bed

treated

third-generation less

developed

requested

as

one central

usually

from

such

and

on

blood

cephems

used

ceftazidime

Gentamicin,

were

1980,

were

commonly cephems,

1987,

treated

also

period. . Medical

and

.

cultures

All

patients

who

were

anticipated

of specimens

from

the

throat,

first

after

the

initial

detected

to have

stool

and

week

neutropenia

urine

of stay

at

of below

admission

in hospital

and

were

500/ƒÊl

then

at

considered

had

surveillance

least

once

acquired

cultures

weekly

. The

were

identified

taken

organisms

.

cultures Blood

criteria

cultures

were

of Cowan

and

Antimicrobial results

expressed

classified the

as

criteria and/or

Bacteremia

due

with

regarded

as

same

the

sequence

was

made The

obvious

by

rating

S.

a triple

aureus

as

disk

of sensitivity

showing -and

Yokota11) after

one

isolates

method

using

from -to™¿The

+ as

those

overnight

resistant

showing on

Tridisks

isolates

. MRSA

resistance

incubation

bacteremia

during

any

the

when

the

infectious

and

at

strains 37•Ž

Mueller-Hinton

admission

had

positive

blood

discharged

period

was

by

(Eiken)

the

. The

showing œO

were

and agar

positive

defined

and™¿ according

sensitivity

(BBL)

and site,

time

as

at

43•Ž

to

.

for two of

foci

autopsy

venous

culture

cultures between

recovery

secondary

or by

of central

blood

blood of

defined

primary

were

evidence

for the

the

same

organism

successive

more

than

positive

one

determined

organism

by

of infection

catheter-associated

organism

isolation

, considering

S . aureus

bacteremia

et al.12) .

considered

on

one

positive

the

suspected

of Mylotte were

was

The

the

at least

Multiple unless

diagnosis

first

focus

on

bacteremia

The

criteria

episodes

of infection

setting.

period.

blood

events.

based

episode

one-week

to the

bacteremic

clinical

Polymicrobial

from

according

was

bacteremic

a week.

of infectious

or

described9).

determined

those

a consistent

organism

symptoms hospital,

by

only

exceeded

of the

and

of S. aureus

a patient

blood

previously

to S. aureus

were

the

as

were

ceftizoxime

from

from

out

a four-graded

sensitive,

diagnosis

cultures

in

described

latamoxef

The

carried

Stee110).

sensitivities

were

were to

, 1972-1991.

were

First-generation

were

used.

staffs

Blood

Diseases

, multiple

antibiotics,

documented,

third-generation

commonly As

. Since agents,

or

which

piperacillin.

nursing

only

in combination.

and

been

ward

suspected

carbenicillin,

second-

period

lymphoma

disorders

chemotherapeutic

aminoglycoside as

20-year

malignant

hematologic

assigned

requiring

tions,

the

in Hematologic

purpura.

patients

nurses

during

leukemia,

Bacteremia

the

hospital-acquired first

positive

culture from

was our

when

blood

culture

obtained

hospital

less . Other

the after

than

patient more

a week

bacteremic

without

than after

signs

48 hours the

episodes

of stay

in

with

an

patient

were

and

classified

as

community-acquired. Shock patients

was or

accompanied

defined

a decrease by

other

as in

a systolic

systolic

signs

of

blood

pressure shock

such

pressure of more as

acute

of than unrest,

less 40

than mmHg

90 from

hyperventilation

mmHg

in

baseline and

previously

normotensive

in hypertensive oliguria

patients

.

Statistics Differences

平 成4年10月20日

between

patient

groups

were

evaluated

using

standard

statistical

methods

(Fisher's

two-

1438

Hisashi

FUNADA

et al

tailed exact test, chi-square analysis with Yates' correction and Student's

unpaired t-test) .

Results Incidence of S. aureus bacteremia During the 20-year period, 1972-1991, S. aureus was isolated from 27 (6%)of a total of 433 episodes of bacteremia complicating hematologic diseases (Table 1). S. aureus bacteremia occurred in 26 (8%)of 333 episodes during the 12-year period, 1980-1991, as compared with only one (1%)of 100 episodes during the 8-year period, 1972-1979 U2=4.987,p