悪性腫瘍患者のVRE血流感染症におけるラインゾリド対ダプトミシン: ニュートロペニーの結果への影響
Ming-Tao Tsai1, Yu-Chung Chuang1, Jia-Ling Yang1
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
まとめ
ニュートロペニアは,バンコミシン耐性腸内球菌感染症 (VRE- BSI) のがん患者のアウトカムを悪化させる. ニュートロペニア患者におけるラインゾリド治療は,ダプトマイシンと比較して死亡率が高かった.
科学分野:
- 感染症
- 血液学
- 腫瘍学
背景:
- バンコミシン耐性腸内球菌感染症 (VRE- BSI) は,悪性腫瘍患者の高い死亡率と関連しています.
- ニュートロペニアは,悪性腫瘍と血流感染症 (BSI) の患者の死亡のリスク因子として知られています.
- VRE- BSIに対するダプトマイシンとラインゾリドの有効性に対する中性不全の影響はよく定義されていません.
研究 の 目的:
- 悪性腫瘍とVRE-BSI患者の14日間の死亡率に対する中性不全の影響を評価する.
- VRE-BSI の中性衰弱と中性衰弱でない患者におけるラインゾリドと高用量ダプトミシンの有効性を比較する.
主な方法:
- 多センターコホート研究では,2010年から2021年の間に悪性腫瘍とVRE- BSIを患った18歳以上の入院患者が含まれていました.
- 患者はラインゾリドまたは高用量ダプトマイシン (≥8 mg/ kg) を投与された.
- 14日間の死亡率のプライマリアウトカムを評価するために,多変量ロジスティック回帰を用いた.
主要な成果:
- 合計474人の患者を分析し,128人 (27. 0%) が中性子減少症であった.
- 14日間の全死亡率は32. 9%でした. 中性衰弱患者 (35. 2%) の死亡率は中性衰弱患者 (32. 1%) よりも高かった.
- 中性衰弱患者では,ラインゾリドはダプトマイシン (40. 8%) と比較して死亡率が高い. 中性衰弱患者におけるラインゾリドの使用は,死亡率増加と関連していた (aOR 8. 48).
結論:
- ニュートロペニアは,VRE-BSI患者で悪化する.
- VRE- BSIのニュートロペニア患者におけるラインゾリド治療は,このコホートにおけるより高い死亡率と関連していました.
- 高用量ダプトマイシンは,特に中性衰弱の患者にとって好ましい選択肢ですが,さらなる研究が必要です.
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