H. Funada et T. Matsuda, Changes in the incidence and etiological patterns of bacteremia associatedwith acute leukemia over a 25-year period, INTERN MED, 37(12), 1998, pp. 1014-1018
During the 25-year period from 1972-1996, 360 episodes of bacteremia occurr
ed in 248 (45 %) of a total of 548 patients with acute leukemia on our hema
tology ward, with the rate of occurrence remaining almost unchanged. Patien
ts with acute nonlymphocytic leukemia, however, had a significant decrease
in the incidence of bacteremia during the last 5-year period. Grant-negativ
e bacilli decreased in relative frequency from 64% for the first 15-year pe
riod to 40 % for the last 5-year period, whereas gram-positive cocci increa
sed from 24% to 51%. Escherichia coli and Enterobacter cloacae somewhat dec
reased in frequency, whereas coagulase-negative staphylococci and streptoco
cci had considerable increases. In contrast, Pseudomonas aeruginosa was Iso
lated at a relatively constant frequency, forming one of the top two pathog
ens throughout the study period. Despite the shift toward gram-positive coc
ci, therefore, P. aeruginosa remains a key organism in considering the init
ial empiric antibiotic regimen and infection prevention during neutropenia.