Long-Term Prophylaxis of Infection by Selective Decontamination in Leukopenia and in Mechanical Ventilation

Clasener, H. A. L.; Vollaard, E. J.; Saene, H. K. F. van

doi:10.1093/clinids/9.2.295

Cited by 81 publications

(18 citation statements)

References 314 publications

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“…These data correspond to those of many authors [4,[11][12][13][14] namely that CNS can be important pathogens in patients receiving immunosuppression therapy. The patients in this study were also infected by CNS and infections have been linked to the use of long-term indwelling venous catheters.…”

Section: Discussionsupporting

confidence: 91%

Value of surveillance cultures in a bone marrow transplantation unit

Czirók

Prinz

Dénes

et al. 1997

Journal of Medical Microbiology

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Because of the increased risk of infection with the associated diagnostic and therapeutic problems in bone marrow transplantation (BMT) patients, the usefulness of surveillance cultures (SC) at the BMT department of the National Institute of Haematology, Blood Transfusion, Transplantation and Immunology, Budapest, was reviewed. Between January 1992 and May 1995, 26 BMT operations were performed; 13 patients had 23 febrile espisodes. In 12 of these episodes infection was clinically documented; however, SC of these patients yielded bacteria identical with those in the blood culture in only two episodes (1 and 6 days before their blood cultures became positive, respectively). Out of a total of 1187 samples from these patients, potentially pathogenic bacteria were isolated from 145 SC and 43 blood cultures (drawn on 31 different days). Suppression of the gastrointestinal flora could be achieved by the department's decontamination regimen; however, overgrowth by gram-positive organisms (mainly coagulase-negative staphylococci) occurred in the intestine and at other body sites. On the basis of these results, SC are of limited value in predicting infection or identifying the causative organisms of fever. On the other hand, SC are useful in confirming the efficiency of suppression of the body flora by antimicrobial agents. Specific treatment was based on suitably sampled materials, and close contact between physicians, infectious disease specialists and microbiologists was essential.

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Section: Discussionsupporting

confidence: 91%

Value of surveillance cultures in a bone marrow transplantation unit

Czirók

Prinz

Dénes

et al. 1997

Journal of Medical Microbiology

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“…Long-term prophylaxis of infection in patients with neutropenia may be achieved by elimination of potentially pathogenic aerobic flora from the digestive tract (3). In order to be effective, antibiotics used for decontamination of the digestive tract must reach high and predictable concentrations in the bowel (15).…”

mentioning

confidence: 99%

Concentration of pefloxacin in feces during infection prophylaxis in neutropenic patients

Leur

Vollaard

Janssen

et al. 1995

Antimicrob Agents Chemother

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Pefloxacin (400 mg twice daily) was administered orally for infection prophylaxis in neutropenic patients. Diffusible fecal pefloxacin concentration was determined by bioassay during 24 neutropenic periods. The median diffusible fecal pefloxacin concentration was 187 g/g. This concentration was comparable with those found in volunteers following oral and intravenous administration of pefloxacin (400 mg twice daily) (median of 171 and 155 g/g, respectively). From this study, it is concluded that pefloxacin administered orally results in a predictable high diffusible fecal concentration which leads to effective elimination of susceptible aerobic gram-negative bacilli from the colonic flora.Fluorinated carboxyquinolones are widely used for infection prophylaxis in patients with severe neutropenia (2, 4). These agents have a broad spectrum of activity against aerobic gramnegative bacilli (GNB) (including Pseudomonas aeruginosa) and are effective in preventing infections by gram-negative organisms (1,5,7,(10)(11)(12)18).Long-term prophylaxis of infection in patients with neutropenia may be achieved by elimination of potentially pathogenic aerobic flora from the digestive tract (3). In order to be effective, antibiotics used for decontamination of the digestive tract must reach high and predictable concentrations in the bowel (15). It has been suggested that nonabsorbable antimicrobial agents are required for this purpose (4). In volunteers, however, we observed high antimicrobial activity of pefloxacin in feces after oral (almost complete resorption) and intravenous administration of pefloxacin (16,17).In the present study, we investigated the diffusible fecal concentration of pefloxacin and eradication of GNB from feces in neutropenic patients following oral administration. We compare these results with those of similar previous studies in healthy volunteers following oral and intravenous administration (16,17).During 24 periods of chemotherapy-induced neutropenia, prophylactic antibiotics, including pefloxacin (400 mg twice a day [BID] orally), fluconazole (50 mg orally), amphotericin B (450 mg BID orally), and trimethoprim (2%, as nasal ointment), were given to decontaminate the digestive tract.All 13 patients (median age, 51 years; range, 49 to 76 years) were treated for a hematologic malignancy, and median duration of neutropenia (Ͻ500 neutrophils per l) was 16 days (range, 9 to 35). During the prophylaxis, no salads were permitted. Fecal samples were taken at admission and twice weekly to determine the diffusible pefloxacin concentration and to perform viable counts of aerobic GNB.The diffusible fecal concentration of pefloxacin was determined by an agar diffusion method. An undiluted aliquot of feces was put in a well (depth, 5 mm; diameter, 7 mm; volume, 0.77 ml) in a solid medium of Iso-Sensitest agar (300 ml; Oxoid, Basingstoke, United Kingdom) seeded with a strain of Escherichia coli (ATCC 25922). The MIC of pefloxacin for this strain is 0.25 g/ml. The diameters of the inhibition zones were compared with t...

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“…Introduction of the fluoroquinolones offered the possibility of achieving selective intestinal decontamination without the disadvantages of TMP-SMX and oral nonabsorbable antibiotics (5,20,44). Indeed, subsequent to the initiation of our study, it has been shown that the fluoroquinolones can prevent gram-negative bacterial infections in granulocytopenic patients (3,7,15,21,23,(40)(41)(42).…”

mentioning

confidence: 89%

“…The latter in particular is capable of preventing infections in some granulocytopenic patient populations (4,18,37,38,43,44). However, limitations of TMP-SMX include lack of efficacy in some groups studied, deficient in vitro activity against Pseudomonas aeruginosa, occasional emergence of bacterial resistance, rash, and potential prolongation of the granulocyte nadir (5,18,29,34,38,44).…”

mentioning

confidence: 99%

Oral enoxacin for infection prevention in adults with acute nonlymphocytic leukemia. The Enoxacin Prophylaxis Study Group

Talbot

Cassileth

Paradiso

et al. 1993

Antimicrob Agents Chemother

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A randomized, double-blind, placebo-controlled trial was conducted in eight hematologic units to determine the efficacy and safety of oral enoxacin for infection prevention in adult patients with acute nonlymphocytic leukemia. One hundred nineteen patients undergoing remission induction or consolidation chemotherapy were enrolled; 62 of them received enoxacin (400 mg orally every 12 h). Patients received antifungal prophylaxis with oral mycostatin (1,000,000 U four times daily) or clotrimazole (1 troche five times daily). Analysis was performed on an intent-to-treat basis. There was no significant difference between groups in race, age, or type and stage of leukemia, but there were more males in the placebo group (P = 0.073 [Fisher's exact test]). Fewer enoxacin patients had gram-negative bacteremia (1 versus 14 [P < 0.001]), gram-negative infection at any site (2 versus 19 [P < 0.001]), or bacterial and/or fungal infection (17 versus 26 [P = 0.056]). There was no significant difference in the number of patients with gram-positive infection at any site (12 versus 16), gram-positive bacteremia (9 versus 10), deep fungal infection (6 versus 2), death (2 versus 3), other antimicrobial therapy required (48 versus 48), therapy with amphotericin B (15 versus 7 [P = 0.105]), any adverse event (45 versus 36), or any study drug-associated adverse events (13 versus 6). Logistic regression confirmed (odds ratios and 95% confidence intervals are given in parentheses) that enoxacin reduced the risk of gram-negative infection (0.07; 0.01 to 0.30), especially gram-negative bacillary bacteremia (0.05; 0.01 to 0.37), without altering the risk of gram-positive bacterial (0.63; 0.26 to 1.5), deep fungal (2.57; 0.47 to 13.9), or Clostridium difficile (1.16; 0.3 to 4.56) infection. The median time to the onset of fever of more than or equal 102.8 F (39.3 degree C) was 32 days for the enoxacin group versus 15 days for patients receiving placebo (P=0.0007 [Wilcoxon test]). In patients with acute nonlymphocytic leukemia, oral enoxacin prevents gram-negative infections, delays the onset of fever, does not alter the incidence of gram-positive or proven deep fungal infections, and is well tolerated.

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Long-Term Prophylaxis of Infection by Selective Decontamination in Leukopenia and in Mechanical Ventilation

Cited by 81 publications

References 314 publications

Value of surveillance cultures in a bone marrow transplantation unit

Value of surveillance cultures in a bone marrow transplantation unit

Concentration of pefloxacin in feces during infection prophylaxis in neutropenic patients

Oral enoxacin for infection prevention in adults with acute nonlymphocytic leukemia. The Enoxacin Prophylaxis Study Group

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