血液疾患患者にみられた緑膿菌菌血症

Abstract

We experienced 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders such as acute leukemia over a 16-year period. All the patients were treated on the same hospital ward. A total of 57 blood culture isolates of P. aeruginosa were divided into nine serogroups. Seventy-four percent of the isolates belonged to four serogroups, which became preponderant one after the other. Surveillance throat and/or stool cultures grew the organisms identical to the isolates from the blood at or prior to the onset of bacteremia in 75% of the episodes. Only 11% of the patients had had P. aeruginosa cultured at admission. The acquisition of the organism was closely associated with antibiotic therapy for other presumed or proved infection. On the other hand, 60% of the episodes occurred during the administration of at least one in vitro effective antibiotic. In five episodes, the patients had received an antipseudomonal penicillin and an aminoglycoside in combination, both of which proved effective in vitro against the infecting organism, when bacteremia occurred. In managing P. aeruginosa bacteremia complicating hematologic disorders, it was thus suggested that surveillance cultures should be regularly carried out, and that attention should be drawn to the occurrence of "breakthrough" bacteremia.