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Use of Selective Decontamination in the Prevention of Infection After Accidental Irradiation

Published online by Cambridge University Press:  28 June 2012

Itzhak Brook  and
G. David Ledney
Itzhak Brook*
Affiliation:
Wound Infection Management Program, Experimental Hematology Department, Armed Forces Radiobiology Research Institute, Bethesda, MD 20889-5145
G. David Ledney
Affiliation:
Wound Infection Management Program, Experimental Hematology Department, Armed Forces Radiobiology Research Institute, Bethesda, MD 20889-5145
*
PO Box 70412, Chevy Chase, MD 20813-0412USA
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Abstract

Exposure to radiation induces a reduction in the number of gastrointestinal, anaerobic bacterial flora, and an increase in the number of Enterobacteriaceae that are associated with sepsis and mortality. Antimicrobials that suppress anaerobic flora have a deleterious effect on survival by promoting earlier enterobacterial sepsis. In contrast, in studies of animals and immunosuppressed patients, antimicrobials that inhibit gram-negative enteric bacteria and preserve the anaerobic flora have shown a beneficial effect by preventing bacterial translocation and fatal sepsis. The quinolone antimicrobials hold potential for therapy of endogenous and exogenous infection after irrodiation.

Keywords

infectionirradiationquinolonesselective decontaminationsepsis
Type
Collective Review
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 1 , March 1993 , pp. 85 - 88
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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References

1. Mathe, G: Total body irradiation injury: A review of the disorders of the blood and hematopoietic tissue and their therapy. In Eszirami, , ed. Nuclear Hematology. New York: Academic Press, 1965, pp 275–338.Google Scholar
2. Kaplan, HW, Speck, RS, Jawetz, F: Impairment of antimicrobial defenses following total body irradiation of mice. J Lab Clin Med 1958;40:682–691.Google Scholar
3. Leroy, GV: The medical sequelae of the atomic bomb explosion. JAMA 1947;134:1143–1148.CrossRefGoogle ScholarPubMed
4. Keller, PD: A clinical syndrome following exposure to atomic bomb explosions. JAMA 1946;131:504–508.CrossRefGoogle ScholarPubMed
5. Miller, CP, Hammond, CW, Tompkins, M: The role of infection in radiation injury. J Lab Clin Med 1951;38:331–343.Google ScholarPubMed
6. Gale, RP: Immediate consequences of nuclear accidents: Lessons from Chernobyl. JAMA 1987;258:625–628.CrossRefGoogle ScholarPubMed
7. Pizzo, PA: Infectious complications in children with cancer. I. Pathophysiology of the compromised host and initial evaluation and management of the febrile cancer patient. J Pediat 1981;98:341–354.CrossRefGoogle ScholarPubMed
8. EORTC International Therapy Project Group. Three antibiotic regimens in the treatment of infection in febrile granulocytopenic patients with cancer. J Infect Dis 1987;137:14–97.Google Scholar
9. Geddes, AM, Stille, W: Imipenem: The first thienamycin antibiotic. Rev Infect Dis 1985;7:353–356.CrossRefGoogle ScholarPubMed
10. Van Der Waaij, D, Hofstra, LT, Wiegersma, N: Effects of beta-lactam antibiotics on the resistance of the digestive tract of mice to colonization. J Infect Dis 1982;146:417–422.CrossRefGoogle ScholarPubMed
11. Bodey, GP: Infection in cancer patients: A continuing association. Am J Med 1986;81:11–26. Supplement 1A.CrossRefGoogle ScholarPubMed
12. Brook, I, Finegold, SM: Aerobic and anaerobic bacteriology of cutaneous abscesses in children. Pediatrics 1981;67:891–896.CrossRefGoogle ScholarPubMed
13. Howerton, EE, Kolmen, SN: The intestinal tract as a portal of entry of Pseudomonas in burned rats. J Trauma 1972;12:335–340.CrossRefGoogle ScholarPubMed
14. Maejima, K, Deitch, E, Berg, R: Promotion from stress of translocation of bacteria from the gastrointestinal tracts of mice. Arch Surg 1984;119:160–172.CrossRefGoogle ScholarPubMed
15. Yates, JW, Holland, JF: A controlled study of isolation and endogenous microbial suppression in acute myelocytic leukemia patients. Cancer 1973;32:1490–1498.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
16. EORTC Gnotobiotic Group: Protective isolation and antimicrobial decontamination in patients with high susceptibility to infection. Infection 1978;6:175–191.CrossRefGoogle Scholar
17. Reiter, B, Gee, T, Young, L, et al. : Use of oral antibiotics during remission induction in adult patients with acute nonlymphoblastic leukemia (ANLL). Clin Res 1973;21:652. Abstract.Google Scholar
18. Stoning, RA, Jameson, B, McElwain, JT, et al. : Oral nonabsorbable antibiotics prevent infection in acute nonlymphoblastic leukemia. Lancet 1977;2:837–840.Google Scholar
19. Bender, JF, Schimpff, SC, Young, VM, et al. : A comparative trial of tobramycin vs. gentamicin in combination with vancomycin and nystatin for alimentary tract suppression in leukemia patients. Eur J Cancer 1979;15:35–44.Google Scholar
20. Gurwith, MJ, Brunton, HL, Land, BA, et al. : A prospective controlled investigation of prophylactic trimethoprim-sulfamethoxazole in hospitalized granulocytopenic patients. Am J Med 1979;66:248–256.CrossRefGoogle ScholarPubMed
21. Enno, A, Catovsky, D, Darrell, J, et al. : Cotrimoxazole for prevention of infection in acute leukemia. Lancet 1978;2:359–397.Google Scholar
22. Dekker, AW, Rozenberg-Arska, M, Sixma, JJ, Verhoef, J: Prevention of infection by trimethoprim-sulfamethoxazole plus amphotericin B in patients with acute nonlymphoblastic leukemia. Ann Intern Med 1981;95:555–559.CrossRefGoogle Scholar
23. Pizzo, PA, Robichaud, KJ, Brenda, KE, et al. : Oral antibiotic prophylaxis in patients with cancer: A double-blind randomized placebo-controlled trial. J Pediat 1983;102:125–133.CrossRefGoogle Scholar
24. Berg, RD: Promotion of the translocation of enteric bacteria for the gastrointestinal tracts of mice by oral treatment with penicillin, clindamycin, or metronidazole. Infect Immun 1981;33:854–861.CrossRefGoogle ScholarPubMed
25. Van Der Waaij, O, Hofstra, IT, Wiegersma, N: Effects of beta-lactam antibiotics on the resistance of the digestive tract of mice to colonization. J Infect Dis 1982;146:417–422.CrossRefGoogle ScholarPubMed
26. Brook, I, Walker, RI, MacVittie, TJ: Effect of antimicrobial therapy on the gut flora and bacterial infection in irradiated mice. Int J Radiat Biol 1988;5:709–716.CrossRefGoogle Scholar
27. Brook, I, Ledney, GD: Effect of antimicrobial therapy on the gastrointestinal bacterial flora infection and mortality in mice exposed to different doses or irradiation. Submitted for publication.Google Scholar
28. Schimpff, SC, Green, WJ, Young, VM, et al. : Infection prevention in acute nonlymphocytic leukemia: Laminar air-flow room reverse isolation with oral, nonabsorbable antibiotic prophylaxis. Ann Intern Med 1975:82:351–358.CrossRefGoogle ScholarPubMed
29. Guiot, HFL, Van Der Meer, JWM, Van Further, R: Selective antimicrobial modulation of human microbial flora: Infection prevention in patients with decreased host defenses mechanism by selective elimination of potential pathogenic bacteria. J Infect Dis 1981;143:351–358.CrossRefGoogle Scholar
30. Rodriguez, V, Bode, GP, Freiereich, EJ, et al. : Randomized trial of protected environment-prophylactic antibiotics in 145 adults with acute leukemia. Medicine (Baltimore) 1978;57:253–266.CrossRefGoogle ScholarPubMed
31. Wade, JC, Schimpff, SC, Hargadon, ML, et al. : A comparison of trimethoprim-sulfamethoxazole plus nystatin with gentamicin plus nystatin in the prevention of infection in acute leukemia. N Engl J Med 1981;304:1057–1062.CrossRefGoogle ScholarPubMed
32. Kovatch, AL, Wald, ER, Albo, VC, et al. : Oral trimethoprim-sulfamedioxazole for prevention of bacterial infection during the induction phase of cancer chemotherapy in children. Pediatrics 1985;76:754–756.CrossRefGoogle ScholarPubMed
33. Henry, SA, Armstrong, D, Kempin, S, et al. : Oral trimethprim-sulfamethoxazole in attempt to prevent infection after induction chemotherapy for acute leukemia. Am J Med 1984;77:663–666.CrossRefGoogle ScholarPubMed
34. 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;18:285–296.CrossRefGoogle ScholarPubMed
35. Wilson, JM, Guiney, DG: Failure of oral trimethoprim-sulfamethoxazole prophylaxis in acute leukemia. Isolation of resistant plasmids for strains of Tnerobacteriaceae causing bacteremia. N Engl J Med 1982;306:16–20.CrossRefGoogle ScholarPubMed
36. Gualtieri, RJ, Donowitz, GR, Kaiser, DL, et al. : Double-blind randomized study of prophylactic trimethoprim-sulfamethoxazole in granulocytopenic patients with hematologic malignancies Am J Med 1983;73:934–940.CrossRefGoogle Scholar
37. Wade, J, Dejongh, C, Newman, K, et al. : Selective antimicrobial modulations prophylaxis against infection during granulocytopenia: Trimethoprim-sulfamethoxazole vs. nalidixic add. J Infect Dis 1983;147:624–634.CrossRefGoogle Scholar
38. Westland, WP, Cornett, JB: Quinolone antibacterial agents. Ann Rep Med Chem 1985;20:145–154.Google Scholar
39. Pecquet, S, Andermont, A, Tancrede, C: Selective antimicrobial modulation of the intestinal tract by norfloxacin in human volunteers and in gnotobiotic mice associated with a human fecal flora. Anlimicrob Agents Chemother 1986;29:1047–1052.CrossRefGoogle ScholarPubMed
40. Arning, M, Wolf, HH, Aul, C, et al. : Infection prophylaxis in neutropenic patients with acute leukemia—a randomized comparative study with ofloxacin, ciprofloxacin, co-trimoxazole, and colisdn. J Antim Chemoth 1990;26:137–142. Supplement D.CrossRefGoogle Scholar
41. 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 in fecal flora. J Infect Dis 1985;142:104–107.CrossRefGoogle Scholar
42. Liang, RH, Young, RWH, Chan, TK, et al. : Ofloxacin versus co-trimoxazole for prevention of infection in neutropenic patients following cytotoxic chemotherapy. Antimicrob Agents Chemother 1990;34:215–218.CrossRefGoogle ScholarPubMed
43. Gluckman, E, Roudet, C, Hirsch, I, et al. : Perol prophylaxis of bacteria infection after bone marrow transplantation. Chemother 1991;37:33–38. Supplement 1.CrossRefGoogle ScholarPubMed
44. Brook, I, Elliott, TB: Pefloxacin therapy in the prevention of mortality after irradiation. Proceedings of the 16th International Congress of Chemotherapy, Jerusalem, Israel. 382.1–382.2. 1989.Google Scholar
45. Brook, I, Ledney, GD: Short and long courses of ofloxacin therapy of Klebsiella pneumoniae sepsis following irradiation. Proceedings of the 30th Interscience Conference of Antimicrobial Agents and Chemotherapy #1013. Adanta, GA, 1990.Google Scholar
46. Brook, I, Ledney, G: Combination therapy of ofloxacin and penicillin-G in the prevention of translocation and mortality after irradiation. Antimicrob Agents Chemother 1991;35:1685–1687.CrossRefGoogle ScholarPubMed
47. Brook, I, Elliott, TB, Ledney, GD: Quinolone therapy of Klebsiella pneumoniae sepsis following irradiation: Comparison of pefloxacin, ciprofloxacin, and ofloxacin. Radiat Res 1990;122:215–217.CrossRefGoogle ScholarPubMed
48. Brook, I, Ledney, GD: Oral ofloxacin therapy of Pseudomonas aeruginosa sepsis in mice after irradiation. Antimicrob Agents Chemother 1990;34:1387–1389.CrossRefGoogle ScholarPubMed
49. Brook, I, Ledney, GD: Oral aminoglycoside and ofloxacin therapy in the prevention of gram-negative sepsis after irradiation. J Infect Dis 1991;146:917–921.CrossRefGoogle Scholar
50. Smith, JT: Ofloxacin, a bactericidal antibacterial. Chemother 1991;37:2–13. Supplement 1.CrossRefGoogle ScholarPubMed