The Influence of Antimicrobial Prophylaxis on the Microbial and Clinical Findings in Patients after Autologous Bone Marrow Transplantation

Abstract

The influence of a prophylactic regimen consisting of ciprofloxacin 250 mg bid, was examined by surveillance cultures from nose, throat, axilla, gingiva, exit site of central venous catheters, blood, rectum and urine of 60 patients undergoing autologous bone marrow transplantation during a 6-year period. None of the 60 patients developed any infectious with Gram-negative rods belonging to the Enterobacteriaceae, or deep fungal infections, during hospitalization. All patients were neutropenic. Febrile episodes were seen in all patients but 3. From 13 patients, microorganisms in the blood, mostly nonhaemolytic streptococci (9/13), were cultured. Surveillance cultures did not predict later infections, but revealed the marked influence of the prophylactic antibiotics on the normal flora. Thus, mainly streptococci, coagulase-negative staphylococci and yeasts were cultured from the sites examined. It is concluded that the future objective of the microbiological surveillance should be restricted to monitoring the possible selection of drug-resistant microorganisms, and that routine cultures of blood and urine are unnecessary.

Fever and neutropenia in pediatric hematopoietic stem cell transplant patients

“…Other series have reported lower rates of bacteremia, ranging from 10-39%. [4][5][6][7][8][12][13][14] This incidence of bacteremia was substantially greater than that observed in episodes of fever and neutropenia in non-transplant chemotherapy settings in which the bacteremia rate is approximately 15-20%. [15][16][17] The higher rate of bacteremia in our series could be related to the fact that antibacterial prophylaxis was not used for the majority of patients and/or that the preparative regimens used produced substantial toxicity to mucosa.…”

“…Reductions in the incidence of gram-negative bacteremia have been reported in other studies employing oral quinolones. 7,9,10 Even if the incidence of fever is not reduced by use of prophylactic oral antibiotics we advocate their use since infection-related death rates are relatively uncommon with gram-positive organisms. Others do not endorse antibacterial prophylaxis with quinolones because of concern over the potential emergence of drug-resistant organisms.…”

Antimicrobial Susceptibility Patterns among Viridans Group Streptococcal Isolates from Infective Endocarditis Patients from 1971 to 1986 and 1994 to 2002

“…Viridans group streptococci cause 20 to 40% of breakthrough bacteremia episodes in neutropenic patients (2,4,9,14,21) and 30 to 40% of native valve infective endocarditis cases (1). In hematology patients, fluoroquinolones are used as antibacterial prophylaxis agents during the neutropenic period after hematopoietic stem cell transplantation or chemotherapy alone (24).…”

Growth stimulation/inhibition effect of medicinal plants on human intestinal microbiota

“…Deleterious effects that antibiotics can produce on the intestinal microbiota of the human are wellknown. Generally, antibiotics have the same effect on normal microbiota as on the pathogens (4).…”