Infection prevention in severely myelosuppressed patients: A comparison between ciprofloxacin and a regimen of selective antibiotic modulation of the intestinal flora

Jansen, Jan; Cromer, Morris; Akard, Luke P.; Black, Jonathan; Wheat, L. Joseph; Allen, Stephen D.

doi:10.1016/0002-9343(94)90063-9

Cited by 23 publications

(10 citation statements)

References 25 publications

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“…Overall infectious-related mortality was relatively low, comparing favorably with the results reported with standard allo-SCT. [35][36][37][38][39] Although this study focused on microbial-documented infections and did not analyze other infectious episodes without bacteremia or candidemia, or other viral non-CMV infections (HSV, VZV, adenovirusesy), one should bear in mind that other nonmicrobial documented infections such as pneumonitis might represent an important issue, since they can result in a high rate of morbidity, impairing patients of the quality of life. Nevertheless, our results suggest that a busulfan-, fludarabine-and ATG-based RIC would result in a different evolution of infections following allo-SCT, as compared to standard allo-SCT or to other RIC regimens.…”

Section: Discussionmentioning

confidence: 99%

“…53 The other important finding of this study was the low incidence of bacteremia following ATG-based RIC allo-SCT, which compares favorably with the 24-55% incidence encountered after autologous or standard allo-SCT. [36][37][38][39] However, RICassociated bacteremia had a late onset, independent of neutropenia or gastrointestinal mucositis, and consisted of mainly Gram-negative bacteria. The predominance of Gramnegative bacteria in our study might be explained by the vancomycin prophylaxis and the absence of Gram-negative bacteria prophylaxis usually used in other protocols.…”

Section: Discussionmentioning

confidence: 99%

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Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen

et al. 2003

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In the setting of reduced-intensity conditioning (RIC) regimens for allogeneic stem cell transplantation (allo-SCT), the epidemiology of transplant-related infections is still poorly defined. In 101 high-risk patients who received an HLA-identical sibling allo-SCT after RIC, including fludarabine, busulfan and antithymocyte globulin (ATG), we report during the first 6 months a cumulative incidence of positive CMV antigenemia of 42% (95% CI 32-52%), developing at a median of 37 (range 7-116) days without evidence of CMV disease (median follow-up, 434 days). The cumulative incidence of bacteremia was 25% (95% CI 17-33%), occurring at a median of 67 (range 7-172) days, while patients had recovered a full neutrophil count. In all, 65% of the bacteremia (95% CI 49-81%) were gram negative. The cumulative incidence of fungal infections was 8% (95% CI 3-13%), with a median onset of 89 (range 7-170) days. In multivariate analysis, stem cell source (bone marrow; P ¼ 0.0002) was significantly associated with the risk of positive CMV antigenemia, while higher doses of prednisone (42 mg/kg) represented the major risk factor for bacteremia (P ¼ 0.0001). Infectious-related mortality was 5% (95% CI 1-9%), with aspergillosis being the principal cause. Collectively, these results suggest that prospective efforts are warranted to develop optimal antimicrobial preventive strategies after RIC allo-SCT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen

et al. 2003

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“…It is difficult to alter these particular risk factors for individual patients prior to HSCT, but many centers use oral antibiotics as either gut decontamination (GD) or bacterial prophylaxis in an attempt to decrease the risk of mucositis‐related bacteremia during this process. However, this practice is controversial, not recommended for routine use based on evidence from the literature and difficult to study as there is no uniformity of antibiotic combinations among different centers 1,23–37.…”

Section: Introductionmentioning

confidence: 99%

Early bacteremia in pediatric hematopoietic stem cell transplant patients on oral antibiotic prophylaxis

Kersun

Propert

Lautenbach

et al. 2005

Pediatr. Blood Cancer

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“…The introduction of broad spectrum fluoroquinolones with both oral and intravenous formulations, a broad spectrum of activity, and few serious toxicities has led many centers to adopt prophylaxis ( 134, 135). Although such use has not documented a reduction in infectious mortality, delays in the onset of first fever during neutropenia were observed in several studies.…”

Section: Prevention and Treatment Of Infectious Syndromes: Frequent Dmentioning

confidence: 99%

Opportunistic infections after blood and marrow transplantation

Wingard

1999

Transplant Infectious Dis

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Opportunistic infections are major causes of morbidity and mortality following bone marrow transplantation. Technological advances in stem cell procurement, the introduction of hematologic growth factors to speed engraftment, the development of new immunosuppressive regimens to control graft-versus-host disease (GVHD), the development of technology to perform graft engineering with removal of T lymphocytes in toto or subpopulations of T lymphocytes, the use of molecular techniques to optimize donor and recipient matching, advances in blood banking, and development of international donor registries, are among the various factors that have led to tremendous changes in transplant practices. Because of such changes in transplant practices, along with the advent of new antimicrobial agents, and development of infection control measures affecting pathogen exposure, alterations in the interplay between host and potential pathogens have occurred. Shifts in the incidence and types of opportunistic pathogens are taking place. Several historically important infectious syndromes are today well controlled; others have diminished in importance early after transplant but are more problematic at a later time; new emerging pathogens are being recognized due to selection pressures from antimicrobial usage and new hosts, such as recipients of alternate donor allogeneic transplant procedures, with even more profound and prolonged immune suppression. Such shifts and new syndromes pose continuing new challenges to the transplant clinician.

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Infection prevention in severely myelosuppressed patients: A comparison between ciprofloxacin and a regimen of selective antibiotic modulation of the intestinal flora

Cited by 23 publications

References 25 publications

Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen

Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen

Early bacteremia in pediatric hematopoietic stem cell transplant patients on oral antibiotic prophylaxis

Opportunistic infections after blood and marrow transplantation

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