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Selective decontamination in neutropenic patients

Published online by Cambridge University Press:  15 May 2009

E. Kurrle ,
T. Schmeiser  and
W. Kern
E. Kurrle*
Affiliation:
Medizinische Klinik II, Klinik am Eichert, D-7320 Göppingen
T. Schmeiser
Affiliation:
Medizinische Klinik II, Klinik am Eichert, D-7320 Göppingen
W. Kern
Affiliation:
Medizinische Klinik und Poliklinik, Universität Ulm, D-7900 Ulm, Germany
*
*Corresponding author: Professor Dr E. Kurrle, Medizinische Klinik II, Klinik am Eichert, Postfach 660, D-7320 Göppingen, Germany
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It is well known that severe neutropenia, as usually seen in patients with acute leukaemia, aplastic anaemia or secondary to aggressive chemotherapy, predisposes to infections with Gram-negative enteric bacilli, Pseudomonas aeruginosa, Staphylococcus aureus, and to fungal infections. Infection with anaerobes, in contrast, is rare in patients with haematologic malignancy [1]. The spectrum of bacterial pathogens in this patient population has recently broadened, and now includes coagulase-negative staphylococci, viridans group streptococci, and, occasionally, coryneforms and other rather unusual opportunistic organisms. All these microorganisms originate either from the patient's own microflora, especially from the digestive tract, or from the hospital environment after having colonized the patient during the hospital stay [2]. Studies have shown that the incidence of fever during periods of severe neutropenia approaches 100%, and most of these fever episodes actually represent bacterial infection. For more than 20 years, methods for the prevention of bacterial and fungal infections have been under investigation in patients with profound neutropenia. These included decontamination trails, oral or systemic antimicrobial prophylaxis, strict reverse isolation and maintenance of germ-free conditions [3–8], prophylactic granulocyte transfusions [9], and, more recently, the application of haemopoietic growth factors [10, 11]. The method which remains the most widely used is oral antimicrobial prophylaxis, especially with agents for so-called selective decontamination of the intestinal tract.

Type
Research Article
Information
Epidemiology & Infection , Volume 109 , Issue 3 , December 1992 , pp. 327 - 335
Copyright
Copyright © Cambridge University Press 1992

References

REFERENCES

1.Singer, C, Kaplan, MH, Armstrong, D. Bacteremia and fungemia complicating neoplastic disease. Am J Med 1977; 62: 731–42.CrossRefGoogle ScholarPubMed
2.Schimpff, SC, Aisner, J, Wiernik, PH. Infection in acute non-lymphocytic leukaemia: the alimentary canal as a major source of pathogens. In: Waaij, D. Van der, Verhoef, J, eds. New criteria for antimicrobial therapy. Amsterdam: Excerpta Medica, 1979; 12–29.Google Scholar
3.Schimpff, SC, Hahn, DM, Brouillet, MD, Young, VM, Fortner, CL, Wiernik, PH. Comparison of basic infection prevention techniques, with standard room reverse isolation or with reverse isolation plus added air filtration. Leuk Res 1978; 2: 231–40.CrossRefGoogle Scholar
4.Dietrich, M, Gaus, W, Vossen, J, van der Waaij, D, Wendt, F. Protective isolation and antimicrobial decontamination in patients with high susceptibility to infection. I. Clinical results. Infection 1977; 5: 107–14.CrossRefGoogle ScholarPubMed
5.Schimpff, SC, Greene, WH, Young, VM, et al. Infection prevention in acute nonlymphocytic leukemia: laminar air flow room reverse isolation with oral, nonabsorbable antibiotic prophylaxis. Ann Intern Med 1975; 82: 351–8.CrossRefGoogle ScholarPubMed
6.Levin, AS, Siegel, SE, Schreiber, AD, et al. Protected environments and prophylactic antibiotics. A prospective controlled study of their utility in the therapy of acute leukemia. N Engl J Med 1973; 288: 477–83.CrossRefGoogle Scholar
7.Bodey, GP, Rodriguez, V, Murphy, WK, Burgess, MA, Benjamin, RS. Protected environment prophylactic antibiotic program for malignant sarcomas: randomized trial during remission induction chemotheraphy. Cancer 1981; 47: 2422–9.3.0.CO;2-Y>CrossRefGoogle Scholar
8.Bodey, GP, Rodriguez, V, Cabanillas, F, Freireich, EJ. Protected environment prophylactic antibiotic program for malignant lymphoma. Am J Med 1979: 66: 74–81.CrossRefGoogle ScholarPubMed
9.Strauss, RG. Are granulocyte transfusions helpful in treating and preventing infections? Haematol Blood Transfusion 1985; 29: 123–31.Google ScholarPubMed
10.Crawford, J. Ozer, H, Stoller, R, et al. Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. N Engl J Med 1991; 325: 164–70.CrossRefGoogle ScholarPubMed
11.B¨chner, T, Hiddemann, W, Königsmann, M, et al. Recombinant human granulocyte-macrophage colony-stimulating factor after chemotheraphy in patients with acute myeloid leukemia at higher age or after relapse. Blood 1991; 78: 1190–7.CrossRefGoogle Scholar
12.Waaij, D. Van der. The colonization resistance of the digestive tract in experimental animals and its consequences for infection prevention. acquisition of new bacteria and the prevention of spread of bacteria between cage mates. In: Waaij, D. Van der, Verhoef, J, eds. New criteria for antimicrobial therapy. Amsterdam: Excerpta Medica, 1979: 43–60.Google Scholar
13.de Vries-Hospers, HG, Welling, GW, Swabb, EA, van der Waaij, D. Selective decontamination of the digestive tract with aztreonam. A study of 10 healthy volunteers. J Infect Dis 1984; 150: 636–42.CrossRefGoogle ScholarPubMed
14.Knothe, H. The effect of a combined preparation of trimethoprim and sulfamethoxazole following short-term and long-term administration on the flora of the human gut. Chemotherapy 1973; 18: 285–96.CrossRefGoogle ScholarPubMed
15.van der Waaij, D, Aberson, J, Thijm, HA, Welling, GW. The screening of four aminoglycosides in the selective decontamination of the digestive tract in mice. Infection 1982; 10: 35–40.CrossRefGoogle ScholarPubMed
16.Bär, W, Welling, GW, Kurrle, E. Effects of selective oral antimicrobial prophylaxis and systemic antibiotics on the fecal flora and fecal beta-aspartylglycine concentration in patients with acute leukemia. Acta Pathol Microbiol Scand 1989; 97: 705–14.CrossRefGoogle ScholarPubMed
17.Krieger, D, Vanek, E, Strehle, R. Influence of total and selective decontamination on the aerobic and anaerobic gastrointestinal flora in patients with acute leukaemia. In: Sasaki, S, Ozawa, A, Hashimoto, K, eds. Recent advances in germfree research. Tokyo: Tokai University Press, 1981: 715–18.Google Scholar
18.Rozenberg-Arska, M, Dekker, AW. Verhoef, J. Ciprofloxacin for selective decontamination of the alimentary tract in patients with acute leukemia during remission induction treatment: the effect on fecal flora. J Infect Dis 1985; 152: 104–7.CrossRefGoogle ScholarPubMed
19.de Vries-Hospers, HG, Welling, GW, Van der, Waaij D.. Norfloxacin for selective decontamination: a study in human volunteers. In: Wostmann, BS, ed. Germfree research: Microflora control and its application to the biomedical sciences. New York: Alan R. Liss, 1985: 259–62.Google Scholar
20.Enzensberger, R, Shah, PM, Knothe, H. Impact of oral ciprofloxacin on the faecal flora of healthy volunteers. Infection 1985; 13: 273–5.CrossRefGoogle ScholarPubMed
21.Kern, W, Kurrle, E, Vanek, E. Ofloxacin for prevention of bacterial infections in granulocytopenic patients. Infection 1987; 15: 427–32.CrossRefGoogle ScholarPubMed
22.Maschmeyer, G, Haralambie, E, Gaus, W et al. . Ciprofloxacin and norfloxacin for selective decontamination in patients with severe granulocytopenia. Infection 1988; 16: 98–104.CrossRefGoogle ScholarPubMed
23.Brumfitt, W, Franklin, I, Grady, D, Hamilton-Miller, JMT, Iliffe, A. Changes in the pharmacokinetics of ciprofloxacin and fecal flora during administration of a 7-day course to human volunteers. Antimicrob Agents Chemother 1984; 26: 757–61.CrossRefGoogle ScholarPubMed
24.Holt, HA, Lewis, DA, White, LO, Bastable, Y, Reeves, DS. Effect of oral ciprofloxacin on the faecal flora of healthy volunteers. Eur J Microbiol 1986; 5: 201–5.CrossRefGoogle ScholarPubMed
25.Peequet, S, Andremont, A, Trancrede, C. Selective antimicrobial modulation of the intestinal tract by norfloxacin in human volunteers and in gnotobiotic mice associated with human fecal flora. Antimicrob Agents Chemother 1986; 29: 1047–52.CrossRefGoogle Scholar
26.Sleijfer, DT, Mulder, NH, de Vries-Hospers, HG et al. . Infection prevention in granulocytopenic patients by selective decontamination of the digestive tract. Eur J Cancer 1980; 16: 859–69.CrossRefGoogle ScholarPubMed
27.Guiot, HFL. van den Broek, PJ. van der Meer, JWM, van Furth, R. Selective antimicrobial modulation of the intestinal flora of patients with acute nonlymphocytic leukemia: a double-blind placebo-controlled study. J Infect Dis 1983; 147: 615–23.CrossRefGoogle ScholarPubMed
28.Kurrle, E, Bhaduri, S, Krieger, D, Pflieger, H, Heimpel, H. Antimicrobial prophylaxis in acute leukaemia: prospective randomized study comparing two methods of selective decontamination. Klin Wochenschr 1983; 61: 691–8.CrossRefGoogle ScholarPubMed
29.Hughes, WT, Kuhn, S, Chaudhary, S, et al. Successful chemoprophylaxis for pneumocystis carinii pneumonitis. N Engl J Med 1977; 297: 1419–26.CrossRefGoogle ScholarPubMed
30.Gurwith, MJ, Brunton, JL, Lank, BA, Harding, GKM. Ronald, AR. A prospective controlled investigation of prophylactic trimethoprim/sulfamethoxazole in hospitalized granulocytopenic patients. Am J Med 1979; 66: 248–56.CrossRefGoogle ScholarPubMed
31.Weiser, B, Lange, M, Fialk, MA, Singer, C. Szatrowski, TH, Armstrong, D. Prophylactic trimethoprim-sulfamethoxazole during consolidation chemotherapy for acute leukemia: a controlled trial. Ann Intern Med 1981; 95: 436–8.CrossRefGoogle ScholarPubMed
32.Dekker, A, Rozenberg-Arska, M, Sixma, JJ, Verhoef, J. Prevention of infection by trimethoprim-sulfamethoxazole plus amphotericin B in patients with acute nonlymphocytic leukemia. Ann Intern Med 1981; 95: 555–9.CrossRefGoogle Scholar
33.Kauffman, C, Liepman, MK, Bergman, AG, Mioduszewski, J. Trimethoprim / sulfamethoxazole prophylaxis in neutropenic patients. Am J Med 1983; 74: 599–607.CrossRefGoogle ScholarPubMed
34.Gualtieri, RJ, Donowitz, GR, Kaiser, DL, Hess, CE, Sande, MA. Double-blind randomized study of prophylactic trimethoprim/sulfamethoxazole in granulocytopenic patients with hematological malignancies. Am J Med 1983; 74: 934–40.CrossRefGoogle Scholar
35.de Jongh, CA, Wade, JC, Finley, RS. Trimethoprim-sulfamethoxazole versus placebo: a double-blind comparison of infection prophylaxis in patients with small cell carcinoma of the lung. J Clin Oncol 1983; 1: 302–7.CrossRefGoogle ScholarPubMed
36.Estey, E, Maksymiuk, A, Smith, T, et al. Infection prophylaxis in acute leukemia. Arch Intern Med 1984; 144: 1562–8.CrossRefGoogle ScholarPubMed
37.EORTC International Antimicrobial Therapy Project Group. Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patients. J Infect Dis 1984; 150: 372–9.CrossRefGoogle Scholar
38.Henry, SA, Armstrong, D, Kempin, S, Gee, T, Arlin, Z, Clarkson, B. Oral trimethoprim/sulfamethoxazole in an attempt to prevent infection after induction chemotherapy for acute leukemia. Am J Med 1984; 77: 663–6.CrossRefGoogle Scholar
39.Karp, JE, Merz, WG, Hendricksen, C, et al. Oral norfloxacin for prevention of Gram-negative bacterial infection in patients with acute leukemia and granulocytopenia. Ann Intern Med 1987; 106: 1–7.CrossRefGoogle ScholarPubMed
40.Hartlapp, JH. Antimicrobial prophylaxis in immunocompromised patients. Drugs 1987; 34: (Suppl 1): 131–3.CrossRefGoogle ScholarPubMed
41.Rozenberg-Arska, M, Dekker, AW, Verhoef, J. Colistin and trimethoprim-sulfamethoxazole for the prevention of infection in patients with acute non-lymphocytic leukaemia. Decrease of the emergence of resistant bacteria. Infection 1983; 11: 167–9.CrossRefGoogle ScholarPubMed
42.Kurrle, E, Dekker, AW, Gaus, W, et al. Prevention of infection in acute leukemia: a prospective randomized study on the efficacy of two different regimens for antimicrobial prophylaxis. Infection 1986; 14: 226–32.CrossRefGoogle Scholar
43.Wade, JC, de Jongh, CA, Newman, KA, Crowley, J, Wiernik, PH, Schimpff, SC. Selective antimicrobial modulation as prophylaxis against infection during granulocytopenia: trimethoprim-sulfamethoxazole vs. nalidixic acid. J Infect Dis 1983; 147: 624–34.CrossRefGoogle ScholarPubMed
44.Starke, ID, Donnelly, P, Catovsky, D, et al. Co-trimoxazole alone for prevention of bacterial infection in patients with acute leukaemia. Lancet 1982; ii: 5–9.CrossRefGoogle Scholar
45.Watson, JG, Jameson, B, Powles, RL, et al. Co-trimoxazole versus non-absorbable antibiotics in acute leukaemia. Lancet 1982; i: 6–9.CrossRefGoogle Scholar
46.Enno, A, Darrell, J, Hows, J, Catovsky, D, Goldmann, JM, Galton, DAG. Co-trimoxazole for prevention of infection in acute leukaemia. Lancet 1978; ii: 395–7.CrossRefGoogle Scholar
47.GIMEMA Infection Program. Prevention of bacterial infection in neutropenic patients with hematologic malignancies. Ann Intern Med 1991; 115: 7–12.CrossRefGoogle Scholar
48.D'Antonio, D, Iacone, A, Fioritoni, G, et al. Antibacterial prophylaxis in granulocytopenic patients: a randomized study of ofloxacin versus norfloxacin. Curr Ther Res 1991; 50: 304–11.Google Scholar
49.Bow, EJ., Rayner, E, Louie, TJ. Comparison of norfloxacin with cotrimoxazole for infection prophylaxis in acute leukemia. Am J Med 1988; 84: 847–54.CrossRefGoogle ScholarPubMed
50.Liang, RHS, Young, RWH, Chan, TW, et al. Ofloxacin versus co-trimoxazole for prevention of infection in neutropenic patients following cytotoxic chemotherapy. Antimicrob Agents Chemother 1990; 34: 215–18.CrossRefGoogle ScholarPubMed
51.Kern, W, Kurrle, E. Ofloxacin versus trimethoprim-sulfamethoxazole for prevention of infection in patients with acute leukemia and granulocytopenia. Infection 1991; 19: 73–80.CrossRefGoogle ScholarPubMed
52.Cruciani, M, Concia, E, Navarra, A, et al. Prophylactic co-trimoxazole versus norfloxacin in neutropenic children – prospective randomized study. Infection 1989; 17: 65–9.CrossRefGoogle Scholar
53.Winston, DJ, Ho, WG, Champlin, RE, et al. Norfloxacin for prevention of bacterial infections in granulocytopenic patients. Am J Med 1987; 82 (Suppl 6B): 40–6.CrossRefGoogle ScholarPubMed
54.Orlandi, E, Navarra, A, Cruciani, M, et al. Norfloxacin versus cotrimoxazole for infection prophylaxis in granulocytopenic patients with acute leukemia. A prospective randomized study. Haematologica 1990; 75: 296–8.Google ScholarPubMed
55.Dekker, AW, Rozenberg-Arska, M, Verhoef, J. Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin. Ann Intern Med 1987; 106: 7–12.CrossRefGoogle ScholarPubMed
56.Maschmeyer, G, Daenen, S, de Pauw, BE, et al. Prevention of infection in acute leukemia. Haematol Blood Transfusion 1990; 33: 525–30.Google ScholarPubMed
57.Winston, DJ, Ho, WG, Nakao, SL, Gale, RP, Champlin, RE. Norfloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients. Am J Med 1986; 80: 884–90.CrossRefGoogle ScholarPubMed
58.Winston, DJ, Ho, WG, Bruckner, DA, Gale, RP, Champlin, RE. Ofloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients. Am J Med 1990; 88: 36–42.CrossRefGoogle ScholarPubMed
59.Pizzo, PA, Robichaud, K, Edwards, BK, Schumaker, C, Kramer, BS, Johnson, A. Oral antibiotic prophylaxis in patients with cancer: a double-blind randomized placebocontrolled trial. J Pediatr 1983; 102: 125–33.CrossRefGoogle Scholar
60.Rozenberg-Arska, M, Dekker, A, Verdonck, L, Verhoef, J. Prevention of bacteremia caused by alpha-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin. Infection 1989; 17: 240–4.CrossRefGoogle ScholarPubMed
61.Warren, RE, Wimperis, JZ, Baglin, TP, et al. Prevention of infection by ciprofloxacin in neutropenia. J Antimicrob Chemother 1990; 26: (Suppl F): 109–23.CrossRefGoogle ScholarPubMed
62.Guiot, HF, Peters, WG, van den Broek, PJ, et al. . Respiratory failure elicited by streptococcal septicaemia in patients treated with cytosine arabinoside, and its prevention by penicillin. Infection 1990; 18: 131–7.CrossRefGoogle ScholarPubMed