Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-24T23:11:22.906Z Has data issue: false hasContentIssue false
  • English
  • Français

Selective decontamination in bone marrow transplant recipients

Published online by Cambridge University Press:  15 May 2009

H. F. L. Guiot  and
R. Van Furth
H. F. L. Guiot*
Affiliation:
Department of Infectious Diseases, University Hospital, P.O. Box 9600, 2300 RC Leiden, The Netherlands
R. Van Furth
Affiliation:
Department of Infectious Diseases, University Hospital, P.O. Box 9600, 2300 RC Leiden, The Netherlands
*
Address for correspondence: Dr H. F. L. Guiot, Dept. of Haematology/Bone Marrow Transplantation, Bldg. 1, C 6–106, University Hospital, 2300 RC Leiden, The Netherlands.
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Patients undergoing bone marrow transplantation become immuno-compromised for various reasons. Deep granulocytopenia, induced by conditioning (chemotherapy and total body irradiation), renders the patient at risk for serious bacterial and fungal infections. Our strategy for prevention of these infections by selective decontamination (SD) is the result of more than 15 years of clinical experience and research. The combination of antibiotics, used as standard SD (neomycin, polymyxin B, pipemidic acid and amphotericin B), with the application of local antimicrobial agents eliminates aerobic Gram-negative rods, Staphylococcus aureus and Candida spp. from the mucosal surfaces of the digestive tract, while the majority of the anaerobic flora persist and support colonization resistance (CR). The antibiotics used either are not resorbed or do not yield therapeutic serum concentrations. Antibiotics which induce therapeutic serum concentrations, such as ciprofloxacin and cotrimoxazole, are only used for SD on a limited scale. When Gram-negative rods persist despite intake of the standard regimen, ciprofloxacin is given until these persisting rods are eliminated. If the patients cannot swallow the oral regimen, i.v. cotrimoxazole is given temporarily. Streptococcal infections are prevented by the i.v. adminstration of penicillin for 14 days starting on the first day after cytotoxic treatment (conditioning for bone marrow transplantation). The combination of SD and systemic prophylaxis has been shown to be adequate; the major problem then remaining is a relatively mild catheter-associated infection with coagulase-negative staphylococci.

Type
Research Article
Information
Epidemiology & Infection , Volume 109 , Issue 3 , December 1992 , pp. 349 - 360
Copyright
Copyright © Cambridge University Press 1992

References

REFERENCES

1.Guiot, HFL. Colonisation resistance and the use of antimicrobial agents for prophylaxis and therapy. Rev Microbiol 1991; 2: 194–9.Google Scholar
2.Van der Waaij, D, Berghuis, JM, Lekkerkerk, JEC. Colonisation resistance of the digestive tract of mice during systemic antibiotic treatment. J Hyg 1972; 70: 605–10.Google ScholarPubMed
3.van Ogtrop, ML, Guiot, HFL, Mattie, H, van Furth, R. Modulation of the intestinal flora of mice by parenteral treatment with broad-spectrum cephalosporins. Antimicrob Ag Chemother 1991; 5: 976–82.CrossRefGoogle Scholar
4.van Ogtrop, ML, Guiot, HFL, Mattie, H, van Strijen, E, Razab, Sekh B, van Furth, R. Modulation of the intestinal flora of mice by treatment with aztreonam and trigemonam. Antimicrob Ag Chemother 1991; 5: 983–5.CrossRefGoogle Scholar
5.van der Meer, JWM, Guiot, HFL, van den Broek, PJ, van Furth, R. Infections in bone marrow transplant recipients. Semin Hematol 1984; 21: 123–40.Google ScholarPubMed
6.Guiot, HFL, Biemond, J, Klasen, E, Gratama, JW, Kramps, JA, Zwaan, FE. Protein loss during acute graft-versus-host disease: diagnostic and clinical significance. Eur J Haematol 1987; 38: 187–96.CrossRefGoogle ScholarPubMed
7.Clift, RA, Buckner, CD, Fefer, A, et al. Infectious complications of marrow transplantation. Transpl Proc 1974; 6: 389–93.Google ScholarPubMed
8.Watson, JG. Problems of infection after bone marrow transplantation. J Clin Pathol 1983; 36 638–92.CrossRefGoogle ScholarPubMed
9.Buckner, CD, Clift, RA, Sanders, JE. Protective environment for marrow transplant recipients. A prospective study. Ann Intern Med 1978; 89: 893–901.CrossRefGoogle ScholarPubMed
10.Storb, R, Prentice, RL, Buckner, CD, et al. Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. N Engl J Med 1983; 308: 302–7.CrossRefGoogle ScholarPubMed
11.Speck, B. Knochenmarktransplantation. Pädiat Fortbildk Praxis 1972; 35: 69–87.Google Scholar
12.Guiot, HFL, van Furth, R. Partial antibiotic decontamination. Br Med J 1977; i: 800–2.Google Scholar
13.Wilson, KH, Sheagren, JH, Freter, R. Selective antimicrobial modulation of human microbial flora. J Infect Dis 1982; 145: 427–8.CrossRefGoogle ScholarPubMed
14.Guiot, HF, van der Meer, JW, van Furth, R. Selective antimicrobial modulation of human microbial flora. J Infect Dis 1982; 145: 428–9.CrossRefGoogle Scholar
15.Guiot, HFL, van der Meer, JWM, Furth, R. Van. Selective antimicrobial decontamination of human microbial flora: infection prevention in patients with decreased host defense mechanisms by selective elimination of potentially pathogenic bacteria. J Infect Dis 1981; 143: 644–54.CrossRefGoogle Scholar
16.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
17.Guiot, HFL, Helmig-Schurter, AV, van der Meer, JWM, van Furth, R. Selective antimicrobial modulation of the intestinal microbial flora for infection prevention in patients with hematologic malignancies. Scand J Infect Dis 1986; 18: 153–60.CrossRefGoogle ScholarPubMed
18.Willemze, R, Peters, WG, van Hennik, MB, et al. Intermediate and high-dose Ara-C and m-AMSA (or daunorubicin) as remission and consolidation treatment for patients with relapsed acute leukaemia and lymphoblastic non-Hodgkin's lymphoma. Scand J Haematol 1985; 34: 83–7.CrossRefGoogle Scholar
19.Peters, WG. Willemze, R. Colly, LP, Guiot, HFL. Side effects of intermediate- and high-dose cytosine arabinoside in the treatment of refractory or relapsed acute leukaemia in non-Hodgkin's lymphoma. Neth J Med 1987; 30: 64–74.Google ScholarPubMed
20.Guiot, HFL, 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
21.van Furth, R, Guiot, HFL. Modulation of the host flora. Eur J Clin Microbiol Infect Dis 1989; 8: 1–7.CrossRefGoogle ScholarPubMed
22.Kern, W, Kurrle, E, Schmeiser, T. Streptococcal bacteremia in adult patients with leukemia undergoing aggressive chemotherapy. A review of 55 cases. Infection 1990; 18: 138–45.CrossRefGoogle ScholarPubMed
23.Dekker, AW, Rozenberg-Arska, M, Sixma, JJ, Verhoef, J. Prevention of infection by trimethoprimsulfamethoxazole plus amphotericin B in patients with non-lymphocytic leukemia. Ann Intern Med 1991; 95: 555–9.CrossRefGoogle Scholar
24.Rozenberg-Arska, M, Dekker, AW, Verhoef, J. Colistin and trimethoprim-sulfamethoxazole for the prevention of infection in patients with acute nonlymphocytic leukaemia. Decrease in the emergence of resistant bacteria. Infection 1983; 11: 167–9.CrossRefGoogle ScholarPubMed
25.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
26.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
27.Guiot, HFL, de Koning, J, de Wilde, H. The interaction between oral adminstration of ciprofloxacin and colonization resistance in mice. Gnotobiology and its Applications. Proc IXth Int Symp on Gnotobiology. Versailles, France, 1987: 415–17.Google Scholar
28.van de Klundert, JAM, van Gestel, MH, Meerdink, G, de Marie, S. Emergence of bacterial resistance to cefamandole in vivo due to outer membrane protein deficiency. Eur J Clin Microbiol Infect Dis 1988; 7: 776–8.CrossRefGoogle ScholarPubMed
29.Jansen, J. Selective gut decontamination in neutropenic patients: a randomized study comparing ciprofloxacin with neomycin/polymyxin-B/nalidixic acid. Proc 10th Int Symp on Gnotobiology, Leiden, The Netherlands 1990. In press.Google Scholar
30.Gratwohl, A, Hermans, J, Barrett, AJ, et al. Allogeneic bone marrow transplantation for leukaemia in Europe. Report from the Working Party on Leukaemia, European Group for Bone Marrow Transplantation. Lancet 1988; i: 1379–82.Google Scholar
31.Zwaan, FE, Fibbe, WE, de Witte, T, Vossen, JMJJ, Gordon-Smith, EC, Goldman, JM. Allogeneic bone marrow transplantation. In: Organ transplantation: Current clinical and immunological concepts. London: Baillière Tindall, 1989: 229–44.Google Scholar
32.Truitt, RL, Bortin, MM, Rimm, AA. Successful adoptive immunotherapy of AKR spontaneous T cell leukemia following antibiotic decontamination and protective isolation. In: Fliedner, T, Heit, H, Niethammer, D, Pflieger, H, eds. Clinical and experimental gnotobiotics. Stuttgart: Gustav Fischer Verlag, 1979: 215–20.Google Scholar
33.Heidt, PJ, Vriesendorp, HM, Zurcher, C, de Groot, CW, Klapwijk, WM. Selective gastrointestinal decontamination in dogs undergoing allogeneic bone marrow transplantation. In: Sasaki, S, Ozawa, A, Hashimoto, K, eds. Recent advances in germfree research. Tokyo: Tokai University Press, 1981: 579–82.Google Scholar
34.Heidt, PJ, Wagemaker, G, Knaan-Shanzer, S, van Bekkum, DW. Two distinct types of late onset graft-versus-host disease after bone marrow transplantation in lethally irradiated mice. Transplantation 1981; 32: 263–4.Google ScholarPubMed
35.Vossen, JM, Heidt, PJ. van den Berg, H, Gerritsen, EJA, Hermans, J, Dooren, LJ. Prevention of infection and graft-versus-host disease by suppression of the intestinal microflora in children treated with allogeneic bone marrow transplantation. Eur J Clin Microbiol Infect Dis 1990: 9: 14–23.CrossRefGoogle ScholarPubMed
36.Guiot, HFL. van der Meer, JWM, Fibbe, WE, de Planque, MM, Zwaan, FE, Biemond, I. The effects of the intestinal microflora of selectively decontaminated patients on the severity of acute graft-versus-host disease of the gut. Exp Hematol 1985: 13 (suppl. 17): 108–9.Google Scholar
37.Guiot, HFL. The effect of the intestinal microflora of selectively decontaminated patients on the severity of acute graft-versus-host disease. Gnotobiology and its applications. Proc IXth Int Symp on Gnotobiology. Versailles, France, 1987: 128–30.Google Scholar
38.de Gast, GC, Gratama, JW, Ringden, O, Gluckman, E. The multifactorial etiology of graft-versus-host disease. Immunol Today 1987; 8: 209–12.CrossRefGoogle ScholarPubMed