Septicemia in Acute Leukemia

With special reference to its bacteriology

抄録

In 25 of 44 patients with acute leukemia admitted to our clinic during the 3-year period ending in 1975, 32 episodes of septicemia in total were found. Septicemia developed in connection with severe granulocytopenia either during remission-induction or at hematologically terminal stages. Multiple organism septicemia was seen in 8 episodes at the terminal stages. The mortality was higher at the terminal stages than during remissioninduction. From the blood were isolated 44 strains of 11 species, of which about twothirds were distributed among 3 species: Escherichia coli, Klebsiella and Pseudomonas aeruginosa. Gentamicin was the most potent drug to gram-negative isolates. The majority of gram-negative septicemias were preceded by isolation of identical strains of the same species from surveillance cultures of the throat and stools. Most of the causative organisms had a close correlation with the preceding antibiotic treatment. The great serologic diversity of the isolates strongly suggested that most septicemias would indeed arise from the patient's ownflora. Serumantibodies to quite a numberof blood strains were demonstrated at the onset or 2 weeks later. Lesions on the respiratory and gastrointestinal tracts were inferred to have provided probable portals of entry for gram-negative bacilli. Thus, the importance of bacteriological surveillance of the endogenous flora was stressed to prevent and control gram-negative septicemia in acute leukemia.