免疫不全病人之敗血症

10.6666/ClinMed.201807_82(1).0073

阮志翰；林邑璁

敗血症(sepsis) ； 臟器器官移植(solid organ transplantation) ； 幹細胞移植(hematopoietic stem cell transplantation)

臨床醫學月刊

82卷1期（2018 / 07 / 27）

403 - 407

繁體中文

敗血症是臨床上重要的問題，也是免疫不全病人重要死因之一。免疫不全病人包括臟器器官移植或是幹細胞移植的病人。根據之前的研究，做過臟器器官移植病人其院內死亡率達40%，而幹細胞移植病人其院內死亡率則是從30%至70%。流行病學統計和病史詢問是了解免疫不全病人得到何種感染症重要的方式。臨床上依感染來源可以分成血管通路裝置相關感染、肺炎、縱膈腔炎(mediastinitis)、急性腹症(acute abdomen)、低嗜中性球發燒及泌尿道感染等。一旦診斷之後，快速給予抗生素、感染源控制並適時調整免疫抑制藥物，以最精準方式治療免疫不全病人之敗血症。

1. Abbott, KC,Oliver, JD, 3rd,Hypolite, I(2001).Hospitalizations for bacterial septicemia after renal transplantation in the United States.Am J Nephrol,21,120-127.
2. Abid, Q,Nkere, UU,Hasan, A(2003).Mediastinitis in heart and lung transplantation: 15 years experience.Ann Thorac Surg,75,1565-1571.
3. Baden, LR,Swaminathan, S,Angarone, M(2016).Preventiontreatment of cancer-related infectionsNCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw,14,882-913.
4. Dettenkofer, M,Wenzler-Rottele, S,Babikir, R(2005).Surveillance of nosocomial sepsis and pneumonia in patients with a bone marrow or peripheral blood stem cell transplant: a multicenter project.Clin Infect Dis,40,926-931.
5. Diez, C,Koch, D,Kuss, O(2007).Risk factors for mediastinitis after cardiacsurgery—a retrospective analysis of 1700 patients.J Cardiothorac Surg,2,23.
6. Fishman, JA(2007).Infection in solid-organ transplant recipients.N Engl J Med,357,2601-2614.
7. Florescu, DF,Qiu, F,Langnas, AN(2012).Bloodstream infections during the first year after pediatric small bowel transplantation.Pediatr Infect Dis J,31,700-704.
8. Freifeld, AG,Bow, EJ,Sepkowitz, KA(2011).Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.Clin Infect Dis,52,e56-e93.
9. Harpaz, R,Dahl, RM,Dooling, KL(2016).Prevalence of immunosuppression among US adults, 2013.JAMA,316,2547-2548.
10. Hsu, RB,Chang, CI,Fang, CT(2011).Bloodstream infection in heart transplant recipients: 12-year experience at a university hospital in Taiwan.Eur J Cardiothorac Surg,40,1362-1367.
11. Kalil, AC,Metersky, ML,Klompas, M(2016).Management of adults with hospitalacquired and ventilatorassociated pneumonia: 2016 clinical practice guidelines by the infectious Diseases Society of America and the American Thoracic Society.Clin Infect Dis,63,e61-e111.
12. Koval, CE,Rakita, R(2013).AST Infectious Diseases Community of Practice. Ventricular assist device related infections and solidorgan transplantation.Am J Transplant,13,348-354.
13. Kumar, G,Ahmad, S,Taneja, A(2015).Severe sepsis in hematopoietic stem cell transplant recipients.Crit Care Med,43,411-421.
14. Linares, L,Garcia-Goez, JF,Cervera, C(2009).Early bacteremia after solid organ transplantation.Transplant Proc,41,2262-2264.
15. Mandell, LA,Wunderink, RG,Anzueto, A(2007).Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.Clin Infect Dis,44,S27-S72.
16. Mermel, LA,Allon, M,Bouza, E(2009).Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America.Clin Infect Dis,49,1-45.
17. Musher, DM,Thorner, AR(2014).Communityacquired pneumonia.N Engl J Med,371,1619-1628.
18. Neofytos, D,Horn, D,Anaissie, E(2009).Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of multicenter prospective antifungal therapy (path) alliance registry.Clin Infect Dis,48,265-273.
19. Parasuraman, R,Julian, K(2013).AST Infectious Diseases Community of Practice. Urinary tract infections in solid organ transplantation.Am J Transplant,13,327-336.
20. Silva, JT,San-Juan, R,Fernandez-Caamano, B(2016).Infectious complications following small bowel transplantation.Am J Transplant,16,951-959.
21. Trouillet, JL,Vuagnat, A,Combes, A(2005).Acute poststernotomy mediastinitis managed with debridement and closeddrainage aspiration: factors associated with death in the intensive care unit.J Thorac Cardiovasc Surg,129,518-524.
22. Wagener, MM,Yu, VL(1992).Bacteremia in transplant recipients: a prospective study of demographics, etiologic agents, risk factors, and outcomes.Am J Infect Control,20,239-247.
23. Wong, A,Marrie, TJ,Garg, S(2010).Increased risk of invasive pneumococcal disease in haematological and solidorgan malignancies.Epidemiol Infect,138,1804-1810.