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Selective decontamination in neutropenic patients

Published online by Cambridge University Press:  15 May 2009

E. Kurrle ,
T. Schmeiser  and
W. Kern
E. Kurrle*
Affiliation:
Medizinische Klinik II, Klinik am Eichert, D-7320 Göppingen
T. Schmeiser
Affiliation:
Medizinische Klinik II, Klinik am Eichert, D-7320 Göppingen
W. Kern
Affiliation:
Medizinische Klinik und Poliklinik, Universität Ulm, D-7900 Ulm, Germany
*
*Corresponding author: Professor Dr E. Kurrle, Medizinische Klinik II, Klinik am Eichert, Postfach 660, D-7320 Göppingen, Germany
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It is well known that severe neutropenia, as usually seen in patients with acute leukaemia, aplastic anaemia or secondary to aggressive chemotherapy, predisposes to infections with Gram-negative enteric bacilli, Pseudomonas aeruginosa, Staphylococcus aureus, and to fungal infections. Infection with anaerobes, in contrast, is rare in patients with haematologic malignancy [1]. The spectrum of bacterial pathogens in this patient population has recently broadened, and now includes coagulase-negative staphylococci, viridans group streptococci, and, occasionally, coryneforms and other rather unusual opportunistic organisms. All these microorganisms originate either from the patient's own microflora, especially from the digestive tract, or from the hospital environment after having colonized the patient during the hospital stay [2]. Studies have shown that the incidence of fever during periods of severe neutropenia approaches 100%, and most of these fever episodes actually represent bacterial infection. For more than 20 years, methods for the prevention of bacterial and fungal infections have been under investigation in patients with profound neutropenia. These included decontamination trails, oral or systemic antimicrobial prophylaxis, strict reverse isolation and maintenance of germ-free conditions [3–8], prophylactic granulocyte transfusions [9], and, more recently, the application of haemopoietic growth factors [10, 11]. The method which remains the most widely used is oral antimicrobial prophylaxis, especially with agents for so-called selective decontamination of the intestinal tract.

Type
Research Article
Information
Epidemiology & Infection , Volume 109 , Issue 3 , December 1992 , pp. 327 - 335
Copyright
Copyright © Cambridge University Press 1992

References

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