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백혈병 환자에서 발생한 침윤성 Aspergillosis 의 임상적 고찰
강문원,김동집,유진홍,김춘추,신완식,박종원,한치화,정희영 대한감염학회 1989 감염 Vol.21 No.3
Invasive aspergillosis is a fatal infectious disease complicating granulocytopenic leukemic patients who received intensive remission-induction chemotherapy. 190 patients with leukemia, admitted from January 1987 to June 1988, were enrolled to this retrospective study. Among them, 92 patients had febrile episodes during remission-induction period, and 14 patients were suspected to have invasive aspergillosis. (8 had pulmonary aspergillosis, 2 rhinocerebral aspergillosis, and 4 both pulmonary and rhinocerebral aspergillosis). Clinical manifestations, predisposing factors, treatment modalities and prognostic factors were analyzed from them. The incidence of invasive aspergillosis was 15.2% among 92 febrile neutropenic patients and the mortality was 42.9%. This complication had occured around the year, but there was a tendency of high incidence in Summer. Fever, chills, and dyspnea were the main clinical manifestations of leukemic patients with invasive pulmonary aspergillosis but their initial PaO₂was almost over 50 mmHg. On the other hand, initial manifestations of rhinocerebral aspergillosis were fever, tenderness on sinus area, and rhinorrhea. Prefound granulocytopenia (below 500mm³) seemed to be one of the major predisposing factors. Both of the total dose and duration of treatment with amphotericin B did not affect the survival rate. The mortality of invasive aspergiollosis developed within 15 days after remission-induction chemotherapy was higher than that developed later. The prognosis of patients with cavitary lesion on chest X-ray film was better than that of the patients with nodular or interstitial lesion.
발열성 과립구 감소증 환자에서 Ceftazidime을 포함한 병합요법과 Piperacillin과 Amikacin 병합요법의 비교
이여민,유진홍,신완식,강문원,한치화,박종원,김춘추,김동집 대한화학요법학회 1989 대한화학요법학회지 Vol.7 No.2
To assess the clinical efficacy of ceftazidime cootaining regimen relative to standard combination antibiotic therapy for the treatment of the febrile granulocytopenic patients, we studied a randomized trial comparing ceftazidime containing regimen with a combination of piperacillin and amikacin. Among 40 evaluable cases of fever and granulocytopenia, 20 were treated with ceftazidime plus amikacin or piperacillin, and the other 20 were treated with piperacillin plus amikacin. The clinical response rates in assessable patients were 66.7% for caftazidime containing regimen and 55.6% for standard combination therapy. The bacteriological clearance rates were 62.5% for ceftazidime containing regimen and 54.5% for standard combination regimen. Efficacy against pseudomonas species appeared to be excellent in ceftazidime containing regimen. Results of therapy according to initial granulocyte count and to the site of infection showed no significant difference in success fate between ceftazidime containing regimen and piperacillin plus amikacin. We conclude that combination antibiotic therepy with ceftazidime will be a good alternative to the other combination antibiotic therapy for the febrile granalocytopenic patients, especially in the hospitals which pseudomonas species are predominant pathogens.