Prevention of Infection in Children with Acute Leukaemia. No Major Difference Between Total and Selective Bowel Decontamination

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 1996 May 1

PMID 8739653

Authors

N Muis

W A Kamps

J Dankert

Affiliations

Soon will be listed here.

Abstract

To evaluate the effect of total bowel decontamination (TD) and selective bowel decontamination (SD) in a non-protective environment clinical and laboratory data of children treated for acute leukaemia between 1983 and 1991 were analysed retrospectively. From 1983 until 1989 34 patients [18 acute non-lymphoblastic leukaemia (ANLL) patients, 16 acute lymphoblastic leukaemia (ALL) patients] received TD and 31 patients (8 ANLL patients, 23 ALL patients) received SD from 1987 until 1991. TD consisted of colistin sulphate, neomycin, cephaloridine and amphotericin B orally as well as Orabase and sterilized food, while the patients were nursed in a single room. SD consisted of oral colistin sulphate, neomycin and amphotericin B. Those patients with ANLL were nursed in a single room; patients with ALL were nursed in a single room during remission induction therapy only. All patients except those with ANLL receiving TD received Pneumocystis carinii pneumonia prophylaxis with cotrimoxazole. Because the two groups were heterogeneous for diagnosis and chemotherapy the occurrence of fever (central body temperature at least 38.5 degrees C) and major infections (septicaemia of infections of the deep tissues or organs) were registered during periods of neutropenia (neutrophilic granulocytes < or = 500/mm3 for at least 8 days). Patients on TD had 55 periods of neutropenia, patients on SD 80. Patients on TD had 89.1 periods of fever/100 periods of neutropenia whereas patients on SD had 56.3. Also patients on TD had 27.3 major infections/100 periods of neutropenia whereas patients on SD had 11.3. Major infections predominantly consisted of septicaemia caused by gram-positive bacteria. We conclude that, in this study, TD in a non-protective environment does not offer better protection against major infections that SD in patients with ALL or ANLL.

References

Pizzo P, Ladisch S, Simon R, Gill F, Levine A . Increasing incidence of Gram-positive sepsis in cancer patients. Med Pediatr Oncol. 1978; 5(1):241-4. DOI: 10.1002/mpo.2950050133. View

Dietrich M, Gaus W, Vossen J, Van Der Waaij D, Wendt F . Protective isolation and antimicrobial decontamination in patients with high susceptibility to infection. A prospective cooperative study of gnotobiotic care in acute leukemia patients. I: clinical results. Infection. 1977; 5(2):107-14. DOI: 10.1007/BF01642091. View

Klastersky J, Debusscher L, Weerts D, Daneau D . Use of oral antibiotics in protected units environment: clinical effectiveness and role in the emergence of antibiotic-resistant strains. Pathol Biol (Paris). 1974; 22(1):5-12. View

Buckner C, Clift R, Sanders J, Meyers J, COUNTS G, Farewell V . Protective environment for marrow transplant recipients: a prospective study. Ann Intern Med. 1978; 89(6):893-901. DOI: 10.7326/0003-4819-89-6-893. View

Pizzo P, Levine A . The utility of protected-environment regimens for the compromised host: a critical assessment. Prog Hematol. 1977; 10:311-32. View

Pizzo P, Robichaud K, Edwards B, Schumaker C, Kramer B, Johnson A . Oral antibiotic prophylaxis in patients with cancer: a double-blind randomized placebo-controlled trial. J Pediatr. 1983; 102(1):125-33. DOI: 10.1016/s0022-3476(83)80310-2. View

Dankert J, Gaus W, Gaya H, Krieger D, LINZENMEIER G, Van Der Waaij D . Protective isolation and antimicrobial decontamination in patients with high susceptibility to infection. A prospective cooperative study of gnotobiotic care in acute leukaemia patients. III: The quality of isolation and decontamination. Infection. 1978; 6(4):175-91. DOI: 10.1007/BF01641908. View

Wade J, Schimpff S, Newman K, Wiernik P . Staphylococcus epidermidis: an increasing cause of infection in patients with granulocytopenia. Ann Intern Med. 1982; 97(4):503-8. DOI: 10.7326/0003-4819-97-4-503. View

Weisman S, Scoopo F, JOHNSON G, Altman A, Quinn J . Septicemia in pediatric oncology patients: the significance of viridans streptococcal infections. J Clin Oncol. 1990; 8(3):453-9. DOI: 10.1200/JCO.1990.8.3.453. View

10.

Verhoef J . Prevention of infections in the neutropenic patient. Clin Infect Dis. 1993; 17 Suppl 2:S359-67. DOI: 10.1093/clinids/17.supplement_2.s359. View

11.

YATES J, HOLLAND J . A controlled study of isolation and endogenous microbial suppression in acute myelocytic leukemia patients. Cancer. 1973; 32(6):1490-8. DOI: 10.1002/1097-0142(197312)32:6<1490::aid-cncr2820320628>3.0.co;2-6. View

12.

Pellegrin J, Fourche J, Marit G, David B, Texier J, Reiffers J . [Intestinal decontamination in the neutropenic patient. Apropos of a prospective randomized study]. Pathol Biol (Paris). 1986; 34(5 Pt 2):676-9. View

13.

van Eys J, Berry D, Crist W, Doering E, Fernbach D, Pullen J . Effect of trimethoprim/sulfamethoxazole prophylaxis on outcome of childhood lymphocytic leukemia. A Pediatric Oncology Group Study. Cancer. 1987; 59(1):19-23. DOI: 10.1002/1097-0142(19870101)59:1<19::aid-cncr2820590108>3.0.co;2-b. View

14.

Pizzo P, Robichaud K, Wesley R, Commers J . Fever in the pediatric and young adult patient with cancer. A prospective study of 1001 episodes. Medicine (Baltimore). 1982; 61(3):153-65. DOI: 10.1097/00005792-198205000-00003. View

15.

Brown A . Management in the febrile, neutropenic patient with cancer: therapeutic considerations. J Pediatr. 1985; 106(6):1035-42. DOI: 10.1016/s0022-3476(85)80265-1. View

16.

Rozenberg-Arska M, Dekker A, Verdonck L, Verhoef J . Prevention of bacteremia caused by alpha-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin. Infection. 1989; 17(4):240-4. DOI: 10.1007/BF01639528. View

17.

Ozawa A, Sawamura S, Yanagawa Y, Nagao T, Sasaki S . Gastrointestinal decontamination in the compromised host and its clinical significance. Tokai J Exp Clin Med. 1985; 10(2-3):181-92. View

18.

Craft A, Reid M, Bruce E, Kernahan J, Gardner P . Role of infection in the death of children with acute lymphoblastic leukaemia. Arch Dis Child. 1977; 52(10):752-7. PMC: 1544806. DOI: 10.1136/adc.52.10.752. View

19.

Levine A, Siegel S, Schreiber A, Hauser J, Preisler H, Goldstein I . Protected environments and prophylactic antibiotics. A prospective controlled study of their utility in the therapy of acute leukemia. N Engl J Med. 1973; 288(10):477-83. DOI: 10.1056/NEJM197303082881001. View

20.

Bagshawe K . ULTRA-CLEAN WARD FOR CANCER CHEMOTHERAPY. Br Med J. 1964; 2(5413):871-2. PMC: 1816275. DOI: 10.1136/bmj.2.5413.871. View